Provider First Line Business Practice Location Address:
5600 OAKLAND AVE
Provider Second Line Business Practice Location Address:
DENTAL HYGIENE ST LOUIS COMMUNITY COLLEGE-FOREST PARK
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63110-1393
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-644-9630
Provider Business Practice Location Address Fax Number:
314-951-9490
Provider Enumeration Date:
05/21/2007