Provider First Line Business Practice Location Address:
5003 US HIGHWAY 160
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PLAINS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65775-7665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-255-8302
Provider Business Practice Location Address Fax Number:
417-255-8389
Provider Enumeration Date:
11/30/2006