Provider First Line Business Practice Location Address:
1225 N 78TH ST STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66112-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-788-8884
Provider Business Practice Location Address Fax Number:
913-788-9598
Provider Enumeration Date:
02/13/2007