Provider First Line Business Practice Location Address:
1604 MISSOURI AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARTHAGE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64836-3059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-358-3361
Provider Business Practice Location Address Fax Number:
417-358-4222
Provider Enumeration Date:
01/08/2007