Provider First Line Business Practice Location Address:
414 N 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POPLAR BLUFF
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63901-5126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-686-1000
Provider Business Practice Location Address Fax Number:
573-686-6877
Provider Enumeration Date:
12/14/2006