Provider First Line Business Practice Location Address:
1605 S. BALTIMORE ST.
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
KIRKSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-665-3599
Provider Business Practice Location Address Fax Number:
660-665-7576
Provider Enumeration Date:
09/28/2011