Provider First Line Business Practice Location Address:
1 SOUTHTOWNE DR.
Provider Second Line Business Practice Location Address:
GREAT MINES HEALTH CENTER
Provider Business Practice Location Address City Name:
POTOSI
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-438-9355
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/09/2007