Provider First Line Business Practice Location Address:
200 E US HIGHWAY 54
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL DORADO SPRINGS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64744-1926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-876-5601
Provider Business Practice Location Address Fax Number:
417-876-5604
Provider Enumeration Date:
11/02/2005