Provider First Line Business Practice Location Address:
225 PHYSICIANS PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
POPLAR BLUFF
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63901-3930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-785-6536
Provider Business Practice Location Address Fax Number:
573-785-0345
Provider Enumeration Date:
03/07/2007