Provider First Line Business Practice Location Address:
222 SCHOOL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65046-1303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-849-2141
Provider Business Practice Location Address Fax Number:
660-849-6123
Provider Enumeration Date:
10/16/2008