Provider First Line Business Practice Location Address:
700 BRANCH ST
Provider Second Line Business Practice Location Address:
BOX 1787
Provider Business Practice Location Address City Name:
PLATTE CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-858-2707
Provider Business Practice Location Address Fax Number:
816-858-5005
Provider Enumeration Date:
03/01/2010