Provider First Line Business Practice Location Address:
113 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64801-2305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-782-2190
Provider Business Practice Location Address Fax Number:
417-782-6750
Provider Enumeration Date:
03/02/2006