Provider First Line Business Practice Location Address:
1233 MEYER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIVERSITY CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63130-1828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-322-3027
Provider Business Practice Location Address Fax Number:
314-725-2696
Provider Enumeration Date:
10/17/2008