Provider First Line Business Practice Location Address:
400 MINE ST.
Provider Second Line Business Practice Location Address:
CITADEL SCHOOL
Provider Business Practice Location Address City Name:
POTOSI
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-438-2472
Provider Business Practice Location Address Fax Number:
573-436-0361
Provider Enumeration Date:
09/30/2014