Provider First Line Business Practice Location Address:
2208 E 55TH ST
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:
64130-3402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-920-3803
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2018