Provider First Line Business Practice Location Address:
104 S. OHIO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMANSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-754-2223
Provider Business Practice Location Address Fax Number:
417-754-8046
Provider Enumeration Date:
09/13/2006