Provider First Line Business Practice Location Address:
605 E HOSPITAL ROAD
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
EL DORADO SPRINGS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-876-3124
Provider Business Practice Location Address Fax Number:
417-876-0054
Provider Enumeration Date:
02/09/2007