Provider First Line Business Practice Location Address:
1000 S 169 HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64089-9322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-873-0202
Provider Business Practice Location Address Fax Number:
816-817-1519
Provider Enumeration Date:
09/16/2006