Provider First Line Business Practice Location Address:
201 NW R D MIZE RD
Provider Second Line Business Practice Location Address:
ST. MARY'S MEDICAL CENTER/ANESTHESIA SERVICES OF BLUE S
Provider Business Practice Location Address City Name:
BLUE SPRINGS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64014-2513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-988-8415
Provider Business Practice Location Address Fax Number:
816-988-8395
Provider Enumeration Date:
07/13/2005