Provider First Line Business Practice Location Address:
116 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:
816-704-5800
Provider Business Practice Location Address Fax Number:
816-704-5793
Provider Enumeration Date:
07/04/2005