Provider First Line Business Practice Location Address:
3217 BROADWAY ST
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64111-2656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-753-5280
Provider Business Practice Location Address Fax Number:
816-753-4219
Provider Enumeration Date:
06/21/2006