Provider First Line Business Practice Location Address:
510 HIGHWAY 322
Provider Second Line Business Practice Location Address:
P O DRAWER 1216
Provider Business Practice Location Address City Name:
CLARKSDALE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38614-4717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-624-2504
Provider Business Practice Location Address Fax Number:
662-627-3629
Provider Enumeration Date:
05/01/2008