Provider First Line Business Practice Location Address:
801 N BALTIMORE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63501-2575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-665-0888
Provider Business Practice Location Address Fax Number:
660-665-6977
Provider Enumeration Date:
01/24/2012