Provider First Line Business Practice Location Address:
500 E 112TH 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:
64131-3623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-942-3337
Provider Business Practice Location Address Fax Number:
816-942-3350
Provider Enumeration Date:
06/30/2020