Provider First Line Business Practice Location Address:
3406 BROADWAY BLVD STE B
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:
64111-2767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-756-5839
Provider Business Practice Location Address Fax Number:
816-756-5874
Provider Enumeration Date:
03/29/2012