Provider First Line Business Practice Location Address:
225 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63456-1341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-735-4112
Provider Business Practice Location Address Fax Number:
573-735-2747
Provider Enumeration Date:
07/13/2005