Provider First Line Business Practice Location Address:
318 E MAIN ST
Provider Second Line Business Practice Location Address:
CENTRAL LAKES MEDICAL CLINIC PA
Provider Business Practice Location Address City Name:
CROSBY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56441-1691
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:
12/13/2005