Provider First Line Business Practice Location Address:
5114 MID AMERICA PLZ
Provider Second Line Business Practice Location Address:
DEPT ORTHOPEDIC SURGERY, STE 1E
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63129-0003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-514-3500
Provider Business Practice Location Address Fax Number:
314-878-7678
Provider Enumeration Date:
06/23/2015