Provider First Line Business Practice Location Address:
2033 N COMMERCIAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISONVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64701-1282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-478-1230
Provider Business Practice Location Address Fax Number:
816-350-4997
Provider Enumeration Date:
08/23/2005