Provider First Line Business Practice Location Address:
819 WALNUT ST
Provider Second Line Business Practice Location Address:
MYDENTIST SUITE 101
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64106-1818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-421-6065
Provider Business Practice Location Address Fax Number:
816-421-5846
Provider Enumeration Date:
02/07/2007