Provider First Line Business Practice Location Address:
11228 MILITARY CLUB RD
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:
64138-3621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-358-8614
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2006