Provider First Line Business Practice Location Address:
225 PHYSICIANS PARK
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
POPLAR BLUFF
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63901-3956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-778-9348
Provider Business Practice Location Address Fax Number:
573-686-4870
Provider Enumeration Date:
04/26/2011