Provider First Line Business Practice Location Address:
6301 N LUCERNE AVE
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:
64151-3105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-569-1802
Provider Business Practice Location Address Fax Number:
816-569-2099
Provider Enumeration Date:
12/27/2013