Provider First Line Business Practice Location Address:
2937 N 73RD ST
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:
66109-1703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-309-4270
Provider Business Practice Location Address Fax Number:
816-430-5511
Provider Enumeration Date:
04/14/2007