Provider First Line Business Practice Location Address:
1200 SIXTH AVE N
Provider Second Line Business Practice Location Address:
CENTRACARE CLINIC RIVER CAMPUS/NEROSURGERY
Provider Business Practice Location Address City Name:
ST CLOUD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56303-2735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-259-1405
Provider Business Practice Location Address Fax Number:
320-259-5896
Provider Enumeration Date:
04/03/2006