Provider First Line Business Practice Location Address:
312 N KENTUCKY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PLAINS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65775-2073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-257-7076
Provider Business Practice Location Address Fax Number:
417-257-1417
Provider Enumeration Date:
09/28/2006