Provider First Line Business Practice Location Address:
903 CLAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLATTSBURG
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64477-0328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-539-2125
Provider Business Practice Location Address Fax Number:
816-539-2521
Provider Enumeration Date:
11/22/2006