Provider First Line Business Practice Location Address:
793 NW 1621ST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATES CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64011-8395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-226-1182
Provider Business Practice Location Address Fax Number:
816-466-8821
Provider Enumeration Date:
06/26/2006