Provider First Line Business Practice Location Address:
106 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLATTSBURG
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64477-1236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-539-2707
Provider Business Practice Location Address Fax Number:
816-930-3712
Provider Enumeration Date:
04/04/2007