Provider First Line Business Practice Location Address:
100 MEDICAL PLAZA DRIVE
Provider Second Line Business Practice Location Address:
ATTN: PHYSICAL THERAPY
Provider Business Practice Location Address City Name:
LAKE ST. LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-625-7749
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2011