Provider First Line Business Practice Location Address:
222 ELIZABETH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HALLSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65255-9492
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-696-3827
Provider Business Practice Location Address Fax Number:
573-696-3391
Provider Enumeration Date:
03/15/2007