Provider First Line Business Practice Location Address:
100 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PATTONSBURG
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-367-4304
Provider Business Practice Location Address Fax Number:
660-367-4350
Provider Enumeration Date:
12/08/2005