Provider First Line Business Practice Location Address:
347 N SMITH AVENUE 302
Provider Second Line Business Practice Location Address:
CHILDRENS PRIMARY CLINIC STPL
Provider Business Practice Location Address City Name:
ST. PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-220-6789
Provider Business Practice Location Address Fax Number:
651-220-6807
Provider Enumeration Date:
08/18/2006