Provider First Line Business Practice Location Address:
6400 PROSPECT AVE
Provider Second Line Business Practice Location Address:
# 598
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64132-4128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-444-6888
Provider Business Practice Location Address Fax Number:
816-444-1375
Provider Enumeration Date:
12/28/2006