Provider First Line Business Practice Location Address:
1400 MADISON AVENUE SUITE 352
Provider Second Line Business Practice Location Address:
MANKATO CLINIC DEPARTMENT OF PSYCHIATRY AND PSYCHOLOGY
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:
507-387-3195
Provider Business Practice Location Address Fax Number:
507-625-8998
Provider Enumeration Date:
09/27/2006