Provider First Line Business Practice Location Address:
119 N BARR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTRALIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65240-1417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-682-0935
Provider Business Practice Location Address Fax Number:
573-682-1369
Provider Enumeration Date:
11/13/2008