Provider First Line Business Practice Location Address:
900 E LAHARPE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63501-4520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-665-1962
Provider Business Practice Location Address Fax Number:
660-665-3989
Provider Enumeration Date:
02/20/2008