Provider First Line Business Practice Location Address:
650 MARYVILLE UNIVERSITY DR
Provider Second Line Business Practice Location Address:
DEPARTMENT OF ATHLETICS
Provider Business Practice Location Address City Name:
ST. LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-529-9314
Provider Business Practice Location Address Fax Number:
314-529-9947
Provider Enumeration Date:
05/23/2007