Provider First Line Business Practice Location Address: 
1 BARNES JEWISH HOSPITAL PLZ
    Provider Second Line Business Practice Location Address: 
DIV IM HOSPITALIST
    Provider Business Practice Location Address City Name: 
SAINT LOUIS
    Provider Business Practice Location Address State Name: 
MO
    Provider Business Practice Location Address Postal Code: 
63110-1003
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
314-362-1700
    Provider Business Practice Location Address Fax Number: 
314-362-9878
    Provider Enumeration Date: 
06/15/2015