Provider First Line Business Practice Location Address:
102 NE STATE ROUTE 92
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64089-8348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-532-0545
Provider Business Practice Location Address Fax Number:
816-532-4710
Provider Enumeration Date:
12/14/2006