Provider First Line Business Practice Location Address:
2905 N 48TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66104-2316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-940-7560
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2007