Provider First Line Business Practice Location Address:
#1 JEFFERSON BARRACKS DRIVE
Provider Second Line Business Practice Location Address:
VA MEDICAL CENTER
Provider Business Practice Location Address City Name:
ST. LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-894-6696
Provider Business Practice Location Address Fax Number:
314-894-6615
Provider Enumeration Date:
08/20/2006