Provider First Line Business Practice Location Address:
2750 CLAY EDWARDS DR
Provider Second Line Business Practice Location Address:
SUITE 604
Provider Business Practice Location Address City Name:
NORTH KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-561-7414
Provider Business Practice Location Address Fax Number:
816-561-6130
Provider Enumeration Date:
01/11/2008