Provider First Line Business Practice Location Address:
101 E. 10TH ST.
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CARUTHERSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-333-1860
Provider Business Practice Location Address Fax Number:
573-333-0099
Provider Enumeration Date:
10/10/2007