Provider First Line Business Practice Location Address:
119 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIERCE CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65723-1228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-476-2828
Provider Business Practice Location Address Fax Number:
417-476-5198
Provider Enumeration Date:
11/07/2006