Provider First Line Business Practice Location Address:
1622 HIGHWAY A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIONTOWN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63783-9115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-788-2345
Provider Business Practice Location Address Fax Number:
573-788-2498
Provider Enumeration Date:
03/28/2007