Provider First Line Business Practice Location Address:
901 S NATIONAL AVE
Provider Second Line Business Practice Location Address:
ALUMNI CENTER 502 LEARNING DIAGNOSTIC CLINIC
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65897-0027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-836-4787
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2007