Provider First Line Business Practice Location Address:
821 BUS HWY 24 WEST
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:
573-735-4113
Provider Business Practice Location Address Fax Number:
573-221-1808
Provider Enumeration Date:
12/18/2012