Provider First Line Business Practice Location Address:
430 W ELK ST
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:
64836-3607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-358-3991
Provider Business Practice Location Address Fax Number:
417-358-7876
Provider Enumeration Date:
12/27/2009