Provider First Line Business Practice Location Address: 
PSYCHOLOGICAL SERVICES CLINIC UNIVERSITY OF MISSOURI
    Provider Second Line Business Practice Location Address: 
211 S. 8TH STREET
    Provider Business Practice Location Address City Name: 
COLUMBIA
    Provider Business Practice Location Address State Name: 
MO
    Provider Business Practice Location Address Postal Code: 
65211-0001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
573-882-2254
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
10/04/2006