Provider First Line Business Practice Location Address:
601 STATE ROUTE 28 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWENSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65066-1450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-437-3440
Provider Business Practice Location Address Fax Number:
573-437-4963
Provider Enumeration Date:
08/12/2006