Provider First Line Business Practice Location Address:
900 E LAHARPE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-626-0698
Provider Business Practice Location Address Fax Number:
660-627-5872
Provider Enumeration Date:
05/22/2007