Provider First Line Business Practice Location Address:
STUDENT SUCCESS CTR RM 0222
Provider Second Line Business Practice Location Address:
CAMPUS BOX 1055
Provider Business Practice Location Address City Name:
EDWARDSVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62026-1055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-650-2850
Provider Business Practice Location Address Fax Number:
618-650-5839
Provider Enumeration Date:
03/18/2013