Provider First Line Business Practice Location Address:
215 W JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63501-3413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-627-1049
Provider Business Practice Location Address Fax Number:
660-627-1354
Provider Enumeration Date:
03/14/2006