Provider First Line Business Practice Location Address:
24252 STATE HIGHWAY 11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-665-1242
Provider Business Practice Location Address Fax Number:
660-665-8283
Provider Enumeration Date:
11/07/2006