Provider First Line Business Practice Location Address:
105 W 12TH ST
Provider Second Line Business Practice Location Address:
105 W. 12TH STREET
Provider Business Practice Location Address City Name:
CARUTHERSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63830-1817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-333-1690
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2008