Provider First Line Business Practice Location Address:
1801 E 24TH ST
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:
64127-3707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-428-7740
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2013