Provider First Line Business Practice Location Address:
1111 KENTUCKY AVE
Provider Second Line Business Practice Location Address:
SHAW MEDICAL BUILDING
Provider Business Practice Location Address City Name:
WEST PLAINS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65775-2010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-257-5959
Provider Business Practice Location Address Fax Number:
417-257-5814
Provider Enumeration Date:
06/17/2008