Provider First Line Business Practice Location Address:
202 LACLAIRE ST BOX 60
Provider Second Line Business Practice Location Address:
LAKE CRYSTAL HEALTH CARE CENTER
Provider Business Practice Location Address City Name:
LAKE CRYSTAL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56055-0060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-726-2669
Provider Business Practice Location Address Fax Number:
507-726-2185
Provider Enumeration Date:
06/03/2006