Provider First Line Business Practice Location Address:
135 S WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64735-2033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-885-7090
Provider Business Practice Location Address Fax Number:
660-885-7787
Provider Enumeration Date:
05/20/2006