Provider First Line Business Practice Location Address:
13905 E 39TH ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64055-3325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-252-5211
Provider Business Practice Location Address Fax Number:
816-252-1025
Provider Enumeration Date:
01/25/2006