Provider First Line Business Practice Location Address:
1444 S OLD HIGHWAY 66
Provider Second Line Business Practice Location Address:
COUNTY OF CRAWFORD PUBLIC SCHOOLS CONS DIST R I
Provider Business Practice Location Address City Name:
BOURBON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65441-6300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-735-5615
Provider Business Practice Location Address Fax Number:
573-732-4407
Provider Enumeration Date:
02/23/2007