Provider First Line Business Practice Location Address:
21 N 12TH ST STE 201
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:
66102-5172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-342-2552
Provider Business Practice Location Address Fax Number:
913-342-3220
Provider Enumeration Date:
07/16/2021