Provider First Line Business Practice Location Address:
2419 N 22ND ST
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:
66104-4612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-371-3995
Provider Business Practice Location Address Fax Number:
866-372-9403
Provider Enumeration Date:
10/24/2007