Provider First Line Business Practice Location Address:
3 MORRIS HALL
Provider Second Line Business Practice Location Address:
DENTAL CLINIC
Provider Business Practice Location Address City Name:
MANKATO
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56001-6043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-389-1313
Provider Business Practice Location Address Fax Number:
507-389-5850
Provider Enumeration Date:
10/16/2006