Provider First Line Business Practice Location Address:
6801 E 117TH ST STE A
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:
64134-3701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-533-6843
Provider Business Practice Location Address Fax Number:
816-767-8399
Provider Enumeration Date:
09/05/2012