Provider First Line Business Practice Location Address:
1400 WEST 9TH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-269-6220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2024