Provider First Line Business Practice Location Address:
1008 SOUTH SPRING AVE
Provider Second Line Business Practice Location Address:
SLUCARE ACADEMIC PAVILLION, 1ST FLOOR
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63110-3714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-977-3470
Provider Business Practice Location Address Fax Number:
314-977-1642
Provider Enumeration Date:
08/12/2009