Provider First Line Business Practice Location Address:
200 N 10TH 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:
63901-4856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-686-7216
Provider Business Practice Location Address Fax Number:
573-686-7217
Provider Enumeration Date:
06/08/2010