Provider First Line Business Practice Location Address:
6238 N CHATHAM 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:
64151-2472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-741-8656
Provider Business Practice Location Address Fax Number:
816-746-1410
Provider Enumeration Date:
04/14/2013