Provider First Line Business Practice Location Address:
201 EAST 6TH ST
Provider Second Line Business Practice Location Address:
BOX 496
Provider Business Practice Location Address City Name:
LAWSON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-296-3252
Provider Business Practice Location Address Fax Number:
816-296-3058
Provider Enumeration Date:
10/12/2005