Provider First Line Business Practice Location Address:
3098 OAK GROVE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POPLAR BLUFF
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63901-8938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-776-9911
Provider Business Practice Location Address Fax Number:
573-776-9913
Provider Enumeration Date:
01/11/2006