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Organization
PAIN TREATMENT CENTER INC
Active
Organization
PAIN TREATMENT CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN DAVID GRAHAM MD (OWNER PRESIDENT)
(314) 872-5601
Entity
Organization
Contact information
Practice address
2821 N BALLAS RD, SUITE C-11, SAINT LOUIS, MO 63131-2321
(314) 872-5601
(314) 872-5628
Mailing address
PO BOX 953010, ST LOUIS, MO 63195-3010
(314) 872-5601
(314) 872-5628
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
036092540
IL
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
109904
MO
Other
Enumeration date
09/29/2006
Last updated
04/05/2010
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