Provider First Line Business Practice Location Address:
4313 MCGEE ST
Provider Second Line Business Practice Location Address:
APT 1N
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64111-1725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-212-3422
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2012