Provider First Line Business Practice Location Address:
4109 SORTOR DR
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:
66104-3707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-602-3167
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2025