Provider First Line Business Practice Location Address:
1110 HIGHWAY 24/36 E SUITE 28
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-735-4880
Provider Business Practice Location Address Fax Number:
573-735-4831
Provider Enumeration Date:
07/30/2006