Provider First Line Business Practice Location Address:
204 WINTER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-735-4545
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2006