Provider First Line Business Practice Location Address:
620 E 18TH ST
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:
64108-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-554-4246
Provider Business Practice Location Address Fax Number:
816-554-4350
Provider Enumeration Date:
09/26/2012