Provider First Line Business Practice Location Address:
201 S BALTIMORE ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
KIRKSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63501-3751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-627-9711
Provider Business Practice Location Address Fax Number:
660-627-7005
Provider Enumeration Date:
11/01/2005