Provider First Line Business Practice Location Address:
575 BLUES LAKE PARKWAY
Provider Second Line Business Practice Location Address:
PCRMC CENTER CLINIC
Provider Business Practice Location Address City Name:
ROLLA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-426-2214
Provider Business Practice Location Address Fax Number:
573-202-2455
Provider Enumeration Date:
04/14/2010