Provider First Line Business Practice Location Address:
3330 LACLEDE AVENUE
Provider Second Line Business Practice Location Address:
SAINT LOUIS UNIVERSITY - CHAIFETZ ARENA
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-977-3295
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2014