Provider First Line Business Practice Location Address:
1200 N ONE MILE RD
Provider Second Line Business Practice Location Address:
MISSOURI SOUTHERN HEALTHCARE
Provider Business Practice Location Address City Name:
DEXTER
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63841-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-614-1957
Provider Business Practice Location Address Fax Number:
573-624-6265
Provider Enumeration Date:
11/02/2005