Provider First Line Business Practice Location Address:
4201 HOLMES ST
Provider Second Line Business Practice Location Address:
APT 3
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64110-1139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-544-5238
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2013