Provider First Line Business Practice Location Address:
1214 W CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARTHAGE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64836-1031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-358-7831
Provider Business Practice Location Address Fax Number:
417-358-9831
Provider Enumeration Date:
07/19/2007