Provider First Line Business Practice Location Address:
201 S CARTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARTERVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64835-1451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-673-3843
Provider Business Practice Location Address Fax Number:
417-673-1160
Provider Enumeration Date:
09/02/2005