Provider First Line Business Practice Location Address:
1010 CARONDELET DR
Provider Second Line Business Practice Location Address:
STE 125
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64114-4846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-942-1150
Provider Business Practice Location Address Fax Number:
816-942-0322
Provider Enumeration Date:
06/09/2005