Provider First Line Business Practice Location Address:
1014 S US HIGHWAY 169
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64089-9321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-532-3400
Provider Business Practice Location Address Fax Number:
816-532-3401
Provider Enumeration Date:
10/13/2007