Provider First Line Business Practice Location Address:
2000 SHELBY RD STE 2-5
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:
63901-2393
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-471-1600
Provider Business Practice Location Address Fax Number:
573-472-7475
Provider Enumeration Date:
10/21/2026