Provider First Line Business Practice Location Address:
410 E 7TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64801-2226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-781-4552
Provider Business Practice Location Address Fax Number:
417-782-1844
Provider Enumeration Date:
12/13/2005