Provider First Line Business Practice Location Address:
181 N KENTUCKY AVE
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:
65775-2089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-256-5100
Provider Business Practice Location Address Fax Number:
417-257-0721
Provider Enumeration Date:
08/08/2006