Provider First Line Business Practice Location Address:
9105 E 89TH 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:
64138-4524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-716-5219
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2024