Provider First Line Business Practice Location Address:
812 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLATTE CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64079-8459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-858-7925
Provider Business Practice Location Address Fax Number:
916-858-7927
Provider Enumeration Date:
12/14/2010