Provider First Line Business Practice Location Address:
16 W 74TH TER
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:
64114-5729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-914-3273
Provider Business Practice Location Address Fax Number:
816-508-3535
Provider Enumeration Date:
01/30/2007