Provider First Line Business Practice Location Address:
901 S. 5TH ST.
Provider Second Line Business Practice Location Address:
FIRST CAPITOL DERMATOLOGY, L.L.C.
Provider Business Practice Location Address City Name:
ST. CHARLES
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63301-2416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-916-1300
Provider Business Practice Location Address Fax Number:
636-916-1561
Provider Enumeration Date:
04/03/2008