Provider First Line Business Practice Location Address:
200 ST. MARY'S MEDICAL PLAZA
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
JEFFERSON CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-634-2014
Provider Business Practice Location Address Fax Number:
573-634-4697
Provider Enumeration Date:
04/16/2007