MISSOURI STATE UNIVERSITY

NPI # 

Practice Address:

1630 N Jefferson Ave

Springfield, MO, 65803-2819

Practice Phone:

417-837-1504

Practice Fax:

417-837-1545

License Number:

2013003462

License State:

MO

Taxonomy Grouping:

Ambulatory Health Care Facilities

Taxonomy Classification:

Clinic/Center

Taxonomy Specialization:

Community Health

Taxonomy Code:

261QC1500X