Provider First Line Business Practice Location Address:
214 W. 5TH ST.
Provider Second Line Business Practice Location Address:
GMMPCPI
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64801-2501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-782-2917
Provider Business Practice Location Address Fax Number:
417-782-7038
Provider Enumeration Date:
03/06/2008