Provider First Line Business Practice Location Address: 
380 E HWY CC, STE A105
    Provider Second Line Business Practice Location Address: 
CC COUNSELING
    Provider Business Practice Location Address City Name: 
NIXA
    Provider Business Practice Location Address State Name: 
MO
    Provider Business Practice Location Address Postal Code: 
65714
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
417-725-8810
    Provider Business Practice Location Address Fax Number: 
417-725-6206
    Provider Enumeration Date: 
11/17/2006