Provider First Line Business Practice Location Address:
120 SOUTH JOHNSON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAHOKA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-727-2722
Provider Business Practice Location Address Fax Number:
660-727-2725
Provider Enumeration Date:
02/26/2007