Provider First Line Business Practice Location Address:
7331 N LEWIS 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:
64158-2001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-400-8331
Provider Business Practice Location Address Fax Number:
816-222-4895
Provider Enumeration Date:
07/11/2011