Provider First Line Business Practice Location Address:
3742 N 113TH ST
Provider Second Line Business Practice Location Address:
KANSAS CITY
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66109-3498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-271-3763
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2011