Provider First Line Business Practice Location Address:
1300 PENNELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARL JUNCTION
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64834-9478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-649-7600
Provider Business Practice Location Address Fax Number:
417-649-7518
Provider Enumeration Date:
09/22/2009