Provider First Line Business Practice Location Address:
HWY 72 N PHYSICIANS OFFICE BUILDING II
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-729-6112
Provider Business Practice Location Address Fax Number:
573-729-4035
Provider Enumeration Date:
09/03/2008