Provider First Line Business Practice Location Address:
223 JONES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMPHREYS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-673-6511
Provider Business Practice Location Address Fax Number:
660-673-6523
Provider Enumeration Date:
02/08/2007