Provider First Line Business Practice Location Address:
2727 MCCLELLAND BLVD
Provider Second Line Business Practice Location Address:
ST. JOHN'S REGIONAL MED CTR PATHOLOGY DEPT
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64804-1626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-625-2130
Provider Business Practice Location Address Fax Number:
417-625-2907
Provider Enumeration Date:
11/02/2010