Provider First Line Business Practice Location Address:
3015 N BALLAS ROAD
Provider Second Line Business Practice Location Address:
MISSOURI BAPTIST MEDICAL CENTER
Provider Business Practice Location Address City Name:
ST LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-548-4715
Provider Business Practice Location Address Fax Number:
314-821-2180
Provider Enumeration Date:
07/13/2006