Provider First Line Business Practice Location Address:
2727 MCCLELLAND BLVD
Provider Second Line Business Practice Location Address:
SPORTSCARE
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64804-1626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-850-1980
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2006