Provider First Line Business Practice Location Address:
1000 HOSPITAL ROAD.
Provider Second Line Business Practice Location Address:
PINEY RIDGE CENTER
Provider Business Practice Location Address City Name:
WAYNESVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65583
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-774-5353
Provider Business Practice Location Address Fax Number:
573-774-2907
Provider Enumeration Date:
01/14/2008