Provider First Line Business Practice Location Address:
801 N. 11TH STREET
Provider Second Line Business Practice Location Address:
ST. LOUIS PUBLIC SCHOOLS
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-231-3720
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2016