Provider First Line Business Practice Location Address:
1406 6TH AVENUE NORTH
Provider Second Line Business Practice Location Address:
ST CLOUD PATHOLOGISTS PA
Provider Business Practice Location Address City Name:
ST CLOUD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56303-1901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-255-5632
Provider Business Practice Location Address Fax Number:
320-255-5734
Provider Enumeration Date:
05/26/2011