Provider First Line Business Practice Location Address:
5330 NW 64TH STREET
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:
64151-2414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-505-7163
Provider Business Practice Location Address Fax Number:
816-505-1768
Provider Enumeration Date:
05/27/2011