Provider First Line Business Practice Location Address: 
UNIVERSITY OF SOUTHERN MISSISSIPPI SPEECH
    Provider Second Line Business Practice Location Address: 
118 COLLEGE DRIVE # 5092
    Provider Business Practice Location Address City Name: 
HATTIESBURG
    Provider Business Practice Location Address State Name: 
MS
    Provider Business Practice Location Address Postal Code: 
39406-0001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
601-266-4968
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
11/24/2009