Provider First Line Business Practice Location Address:
100 E. NORMAL STREET
Provider Second Line Business Practice Location Address:
MCKINNEY BUILDING
Provider Business Practice Location Address City Name:
KIRKSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-785-4182
Provider Business Practice Location Address Fax Number:
660-785-4011
Provider Enumeration Date:
10/21/2008