Provider First Line Business Practice Location Address:
5536 NE ANTIOCH RD
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:
64119-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-454-5818
Provider Business Practice Location Address Fax Number:
816-454-5994
Provider Enumeration Date:
05/14/2007