Provider First Line Business Practice Location Address:
1734 E 63RD ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64110-3543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-333-9999
Provider Business Practice Location Address Fax Number:
816-333-1943
Provider Enumeration Date:
02/27/2007