Provider First Line Business Practice Location Address:
333 W 46TH TER
Provider Second Line Business Practice Location Address:
APT 209
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64112-1545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-556-5232
Provider Business Practice Location Address Fax Number:
515-556-5232
Provider Enumeration Date:
05/31/2007