Provider First Line Business Practice Location Address:
21 N 12TH ST
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66102-5161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-621-2870
Provider Business Practice Location Address Fax Number:
913-621-1633
Provider Enumeration Date:
03/20/2006