Provider First Line Business Practice Location Address:
632 KANSAS AVENUE
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:
66105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-371-1017
Provider Business Practice Location Address Fax Number:
913-371-8326
Provider Enumeration Date:
07/31/2006