Provider First Line Business Practice Location Address:
11812 E. 61ST. STREET
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:
64133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-830-6405
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2014