Provider First Line Business Practice Location Address: 
4401 WORNALL RD
    Provider Second Line Business Practice Location Address: 
ANESTHESIA DEPT.
    Provider Business Practice Location Address City Name: 
KANSAS CITY
    Provider Business Practice Location Address State Name: 
MO
    Provider Business Practice Location Address Postal Code: 
64111-3220
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
816-389-6030
    Provider Business Practice Location Address Fax Number: 
816-389-6034
    Provider Enumeration Date: 
10/18/2011