Provider First Line Business Practice Location Address:
7076 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:
816-832-4299
Provider Business Practice Location Address Fax Number:
816-817-1427
Provider Enumeration Date:
06/03/2017