Provider First Line Business Practice Location Address:
401 WASHINGTON AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PLAINS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65775-3444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-256-8722
Provider Business Practice Location Address Fax Number:
417-256-8733
Provider Enumeration Date:
01/26/2007