Provider First Line Business Practice Location Address:
1305 SALEM ST
Provider Second Line Business Practice Location Address:
OAK GROVE R-6 SCHOOL DISTRICT
Provider Business Practice Location Address City Name:
OAK GROVE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64075-7044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-690-4156
Provider Business Practice Location Address Fax Number:
816-690-3031
Provider Enumeration Date:
08/21/2007