Provider First Line Business Practice Location Address:
12107 E 43RD 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:
64133-2060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-872-9485
Provider Business Practice Location Address Fax Number:
816-841-4989
Provider Enumeration Date:
08/31/2010