Provider First Line Business Practice Location Address:
318 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
CENTERAL LAKES MEDICAL CLINIC, P.A.
Provider Business Practice Location Address City Name:
CROSBY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56441-1645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-546-8375
Provider Business Practice Location Address Fax Number:
218-546-4400
Provider Enumeration Date:
10/04/2006