Provider First Line Business Practice Location Address:
600 N MAIN ST
Provider Second Line Business Practice Location Address:
VA CLINIC
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65712-1004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-466-0141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2006