Provider First Line Business Practice Location Address:
3114 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARTHAGE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64836-1211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-358-0188
Provider Business Practice Location Address Fax Number:
417-358-4612
Provider Enumeration Date:
12/21/2011