Provider First Line Business Practice Location Address:
520 N BALTIMORE 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:
63501-3214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-665-3370
Provider Business Practice Location Address Fax Number:
660-665-3394
Provider Enumeration Date:
02/06/2008