Provider First Line Business Practice Location Address:
2305 MINNESOTA BLVD
Provider Second Line Business Practice Location Address:
MINN CORRECTIONAL FACILITY
Provider Business Practice Location Address City Name:
SAINT CLOUD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56304-2424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-240-3088
Provider Business Practice Location Address Fax Number:
320-240-7087
Provider Enumeration Date:
11/01/2006