Provider First Line Business Practice Location Address:
12647 OLIVE BLVD
Provider Second Line Business Practice Location Address:
SPECTRUM HEALTHCARE RESOURCES
Provider Business Practice Location Address City Name:
ST. LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-460-9862
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2006