Provider First Line Business Practice Location Address:
225 PHYSICIANS PARK STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POPLAR BLUFF
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63901-3923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-727-5500
Provider Business Practice Location Address Fax Number:
573-727-5599
Provider Enumeration Date:
01/04/2006