Provider First Line Business Practice Location Address:
2101 LAKEVIEW RD
Provider Second Line Business Practice Location Address:
SPECIAL SERVICES -- CLAIM CARE
Provider Business Practice Location Address City Name:
MEXICO
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65265-1358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-581-3773
Provider Business Practice Location Address Fax Number:
573-581-1794
Provider Enumeration Date:
08/29/2012