Provider First Line Business Practice Location Address:
12380 DEPAUL DR.
Provider Second Line Business Practice Location Address:
SSM REHABILITATION HOSPITAL - PHYSICIAN'S SERVICES
Provider Business Practice Location Address City Name:
BRIDGETON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63044-2588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-447-9705
Provider Business Practice Location Address Fax Number:
314-447-9706
Provider Enumeration Date:
08/31/2006