Provider First Line Business Practice Location Address:
374 W COMMERCIAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAHOKA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63445-1453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-727-3677
Provider Business Practice Location Address Fax Number:
660-727-2222
Provider Enumeration Date:
07/25/2006