Provider First Line Business Practice Location Address:
1008 S. SPRING AVE.
Provider Second Line Business Practice Location Address:
SLUCARE ACADEMIC PAVILION, ROOM 2412, NEPHROLOGY
Provider Business Practice Location Address City Name:
ST. LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-977-2650
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2011