Provider First Line Business Practice Location Address:
JOPLIN HIGH SCHOOL
Provider Second Line Business Practice Location Address:
2104 INDIANA AVE.
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-625-5230
Provider Business Practice Location Address Fax Number:
417-625-5238
Provider Enumeration Date:
12/01/2006