Provider First Line Business Practice Location Address:
42 W CONCORD 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:
64112-2830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-523-3736
Provider Business Practice Location Address Fax Number:
816-523-7089
Provider Enumeration Date:
01/02/2008