Provider First Line Business Practice Location Address: 
1000 E HIGHWAY 60
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
MONETT
    Provider Business Practice Location Address State Name: 
MO
    Provider Business Practice Location Address Postal Code: 
65708-8258
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
417-354-1500
    Provider Business Practice Location Address Fax Number: 
417-354-1585
    Provider Enumeration Date: 
08/13/2008