Provider First Line Business Practice Location Address:
2320 N 37TH 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:
66104-3634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-375-7991
Provider Business Practice Location Address Fax Number:
913-904-3413
Provider Enumeration Date:
11/18/2018