Provider First Line Business Practice Location Address:
1103 S. 169 HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-532-0977
Provider Business Practice Location Address Fax Number:
816-532-8444
Provider Enumeration Date:
08/05/2014