Provider First Line Business Practice Location Address:
516 EAST 63RD 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:
64110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-523-4455
Provider Business Practice Location Address Fax Number:
816-523-8511
Provider Enumeration Date:
07/12/2006