Provider First Line Business Practice Location Address:
215 S BARNES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65802-2204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-864-3430
Provider Business Practice Location Address Fax Number:
417-864-3449
Provider Enumeration Date:
01/05/2007