Provider First Line Business Practice Location Address:
515 NORTH JEFFERSON
Provider Second Line Business Practice Location Address:
VA HOPE RECOVERY CENTER
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-609-9248
Provider Business Practice Location Address Fax Number:
314-289-6543
Provider Enumeration Date:
01/10/2007