Provider First Line Business Practice Location Address:
201 S ARTHUR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMANSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65674-8400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-754-2223
Provider Business Practice Location Address Fax Number:
417-754-8046
Provider Enumeration Date:
07/09/2016