Provider First Line Business Practice Location Address:
901 SOUTH SPRUCE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATES CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64011-9707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-896-0416
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2011