Provider First Line Business Practice Location Address:
203 E MARKET ST
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:
64011-9745
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:
816-690-3147
Provider Enumeration Date:
12/22/2011