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Organization

ST. LOUIS BREAST CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. RICHARD MUCKERMAN III M.D. (PRESIDENT)
(314) 409-2108
Entity
Organization

Contact information

Practice address
884 WOODS MILL RD, SUITE 203, BALLWIN, MO 63011-3657
(636) 779-8008
Mailing address
884 WOODS MILL RD, SUITE 203, BALLWIN, MO 63011-3657
(636) 779-8008

Taxonomy

Speciality
Code
Description
License number
State
261QR0206X
Mammography Clinic/Center
Primary
MO

Other

Enumeration date
11/29/2010
Last updated
11/29/2010
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