Provider First Line Business Practice Location Address:
1702 E LAHARPE 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:
63501-3981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-785-2500
Provider Business Practice Location Address Fax Number:
660-785-2520
Provider Enumeration Date:
11/09/2006