Provider First Line Business Practice Location Address:
9051 NE 81ST TERRACE
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-781-5437
Provider Business Practice Location Address Fax Number:
816-781-4358
Provider Enumeration Date:
06/06/2007