Provider First Line Business Practice Location Address:
ONE CHILDREN'S PLACE
Provider Second Line Business Practice Location Address:
8E-6 SAINT LOUIS CHILDREN'S HOSPITAL
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63110-1077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-454-5458
Provider Business Practice Location Address Fax Number:
314-454-6225
Provider Enumeration Date:
09/01/2010