Provider First Line Business Practice Location Address:
6420 PROSPECT AVE
Provider Second Line Business Practice Location Address:
T303
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-333-1919
Provider Business Practice Location Address Fax Number:
816-361-1930
Provider Enumeration Date:
04/26/2006