Provider First Line Business Practice Location Address:
1428 S 32ND ST
Provider Second Line Business Practice Location Address:
UPPER LEVEL
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66106-2106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-299-0089
Provider Business Practice Location Address Fax Number:
913-299-0873
Provider Enumeration Date:
10/03/2006