Provider First Line Business Practice Location Address:
2530 LUCY LEE PKWY STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POPLAR BLUFF
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63901-2436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-686-7575
Provider Business Practice Location Address Fax Number:
573-686-5199
Provider Enumeration Date:
04/07/2006