Provider First Line Business Practice Location Address:
65 COUNTY ROAD 527
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POPLAR BLUFF
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63901-8029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-785-4600
Provider Business Practice Location Address Fax Number:
573-785-3611
Provider Enumeration Date:
08/17/2011