Provider First Line Business Practice Location Address:
200 WASHINGTON STREET
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
PURDY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-442-3020
Provider Business Practice Location Address Fax Number:
417-442-0101
Provider Enumeration Date:
03/14/2007