Provider First Line Business Practice Location Address:
AMBULATORY CARE CENTER
Provider Second Line Business Practice Location Address:
1225 S. GRAND BLVD
Provider Business Practice Location Address City Name:
ST LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63104-1016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-577-8765
Provider Business Practice Location Address Fax Number:
314-771-0784
Provider Enumeration Date:
08/10/2006