Provider First Line Business Practice Location Address:
2636 N 51ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66104-3127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-944-2236
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2026