Provider First Line Business Practice Location Address:
220 E MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 204 MANKATO CHILD PSYCHOLOGY CLINIC PA
Provider Business Practice Location Address City Name:
MANKATO
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-345-5590
Provider Business Practice Location Address Fax Number:
507-345-3550
Provider Enumeration Date:
09/25/2006