Provider First Line Business Practice Location Address:
21 N 12TH STREET
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-371-1667
Provider Business Practice Location Address Fax Number:
913-371-2798
Provider Enumeration Date:
05/04/2007