Provider First Line Business Practice Location Address:
16830 198TH AVE NW
Provider Second Line Business Practice Location Address:
CENTRACARE CLINIC - BIG LAKE
Provider Business Practice Location Address City Name:
BIG LAKE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55309-4860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-263-7300
Provider Business Practice Location Address Fax Number:
763-263-7338
Provider Enumeration Date:
10/01/2007