Provider First Line Business Practice Location Address:
275 UNION BLVD
Provider Second Line Business Practice Location Address:
DIV CHILD AND ADOLESCENT PSYCHIATRY
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63108-1231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-537-0146
Provider Business Practice Location Address Fax Number:
314-747-6777
Provider Enumeration Date:
05/12/2014