Provider First Line Business Practice Location Address:
24832 STATE HIGHWAY 39
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELL KNOB
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65747-8417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-858-2200
Provider Business Practice Location Address Fax Number:
417-858-2216
Provider Enumeration Date:
07/25/2006