Provider First Line Business Practice Location Address:
817 S. MOUNT AUBURN, SUITE 100
Provider Second Line Business Practice Location Address:
SOUTHEAST PRIMARY CARE
Provider Business Practice Location Address City Name:
CAPE GERARDEAU
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-519-4500
Provider Business Practice Location Address Fax Number:
573-519-4530
Provider Enumeration Date:
08/20/2007