Provider First Line Business Practice Location Address:
1900 CENTRA CARE CIR #1300
Provider Second Line Business Practice Location Address:
CENTRA CARE CLINIC WOMEN'S & CHILDREN'S
Provider Business Practice Location Address City Name:
ST CLOUD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56303-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-654-3610
Provider Business Practice Location Address Fax Number:
320-654-3657
Provider Enumeration Date:
10/28/2005