Provider First Line Business Practice Location Address:
5351 DELMAR BLVD
Provider Second Line Business Practice Location Address:
METROPOLITAN ST LOUIS PSYCHIATRIC 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:
63112-3146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-877-0611
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2014