Provider First Line Business Practice Location Address:
211 S OWEN ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CALIFORNIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65018-1115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-796-2145
Provider Business Practice Location Address Fax Number:
573-796-6123
Provider Enumeration Date:
12/12/2006