Provider First Line Business Practice Location Address:
1740 JEFFERSON 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:
64108-1104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-471-2536
Provider Business Practice Location Address Fax Number:
816-471-2521
Provider Enumeration Date:
06/15/2007