Provider First Line Business Practice Location Address:
450 E 4TH ST
Provider Second Line Business Practice Location Address:
# 200
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64106-1170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-753-5736
Provider Business Practice Location Address Fax Number:
816-753-5738
Provider Enumeration Date:
04/19/2006