Provider First Line Business Practice Location Address:
1 JEFFERSON BARRACKS DRIVE
Provider Second Line Business Practice Location Address:
PSYCHOLOGY SERVICE (116A-JB)
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-894-4788
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2006