Provider First Line Business Practice Location Address:
6400 N COSBY AVE
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:
64151-2377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-587-1320
Provider Business Practice Location Address Fax Number:
816-587-7485
Provider Enumeration Date:
01/16/2013