Provider First Line Business Practice Location Address:
615 SOUTH NEW BALLAS
Provider Second Line Business Practice Location Address:
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
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:
314-251-6462
Provider Business Practice Location Address Fax Number:
314-251-4492
Provider Enumeration Date:
06/14/2012