Provider First Line Business Practice Location Address:
VA MEDCIAL CENTER (116 A/JB)
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ONE JEFFERSON BARRACKS DR
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-487-0400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2006