Provider First Line Business Practice Location Address:
1101 W LIBERTY ST
Provider Second Line Business Practice Location Address:
DEPT. OF RADIOLOGY
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63640-1921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-760-8075
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2006