Provider First Line Business Practice Location Address:
217 DIVISION ST
Provider Second Line Business Practice Location Address:
SPARTA R III
Provider Business Practice Location Address City Name:
SPARTA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65753-0160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-634-3223
Provider Business Practice Location Address Fax Number:
417-634-3156
Provider Enumeration Date:
09/17/2007