Provider First Line Business Practice Location Address:
1421 W 47TH 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:
64112-1103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-941-6226
Provider Business Practice Location Address Fax Number:
816-941-6336
Provider Enumeration Date:
11/12/2010