Provider First Line Business Practice Location Address:
NORTHWEST MISSOURI STATE UNIVERSITY
Provider Second Line Business Practice Location Address:
800 UNIVERSITY DRIVE, LAC 45
Provider Business Practice Location Address City Name:
MARYVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64468-2712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-562-1545
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2007