Provider First Line Business Practice Location Address: 
NEVADA REGIONAL MEDICAL CENTER
    Provider Second Line Business Practice Location Address: 
800 SOUTH ASH
    Provider Business Practice Location Address City Name: 
NEVADA
    Provider Business Practice Location Address State Name: 
MO
    Provider Business Practice Location Address Postal Code: 
64772
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
417-448-3649
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
05/09/2007