Provider First Line Business Practice Location Address:
6400 E 23RD 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:
64129-1103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-418-4775
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2017