Provider First Line Business Practice Location Address:
112 N BRIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64089-8176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-532-6338
Provider Business Practice Location Address Fax Number:
816-532-6339
Provider Enumeration Date:
07/03/2007