Provider First Line Business Practice Location Address:
501 WEST COLLEGE DRIVE
Provider Second Line Business Practice Location Address:
CENTRAL LAKES COMMUNITY DENTAL CLINIC
Provider Business Practice Location Address City Name:
BRAINERD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-855-8272
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2006