Provider First Line Business Practice Location Address:
6028 N SPRUCE AVE
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:
64119-5314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-455-3909
Provider Business Practice Location Address Fax Number:
816-455-3909
Provider Enumeration Date:
05/17/2007