Provider First Line Business Practice Location Address:
HIGHWAY 82 STUDENT HEALTH CLINIC
Provider Second Line Business Practice Location Address:
MISSISSIPPI VALLEY STATE UNIVERSITY
Provider Business Practice Location Address City Name:
ITTA BENA
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-254-3331
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2009