Provider First Line Business Practice Location Address:
225 PHYSICIANS PARK STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POPLAR BLUFF
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63901-3923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-772-7722
Provider Business Practice Location Address Fax Number:
573-778-7282
Provider Enumeration Date:
09/01/2006