Provider First Line Business Practice Location Address:
101 E ADRIATIC ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64061-9202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-597-3422
Provider Business Practice Location Address Fax Number:
816-597-3702
Provider Enumeration Date:
05/10/2010