Provider First Line Business Practice Location Address:
100 ST. MARY'S MEDICAL PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-761-7011
Provider Business Practice Location Address Fax Number:
573-636-4819
Provider Enumeration Date:
02/09/2007