Provider First Line Business Practice Location Address:
1201 W 136TH 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:
64145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-412-0111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2006