Provider First Line Business Practice Location Address:
4220 SHAWNEE MISSION PKWY
Provider Second Line Business Practice Location Address:
SUITE 210 B
Provider Business Practice Location Address City Name:
FAIRWAY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-362-4488
Provider Business Practice Location Address Fax Number:
913-362-6652
Provider Enumeration Date:
12/08/2006