Provider First Line Business Practice Location Address:
105 NORTH OHIO ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMANSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65674-0086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-754-8811
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2007