Provider First Line Business Practice Location Address:
7006 UNIVERSAL AVE
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:
64120-1370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-429-7468
Provider Business Practice Location Address Fax Number:
816-429-7469
Provider Enumeration Date:
06/24/2014