Provider First Line Business Practice Location Address:
300 NORTH GRAND AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KING CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64463-0189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-535-4319
Provider Business Practice Location Address Fax Number:
660-535-4765
Provider Enumeration Date:
06/26/2007