Provider First Line Business Practice Location Address:
331 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POPLAR BLUFF
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63901-5154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-686-5488
Provider Business Practice Location Address Fax Number:
573-686-5488
Provider Enumeration Date:
03/06/2007