Provider First Line Business Practice Location Address:
105 W 34TH ST
Provider Second Line Business Practice Location Address:
2
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64111-1315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-572-1152
Provider Business Practice Location Address Fax Number:
816-817-6603
Provider Enumeration Date:
09/04/2012