Provider First Line Business Practice Location Address:
1400 HIGHLAND CENTER
Provider Second Line Business Practice Location Address:
MINNESOTA STATE UNIVERSITY
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:
507-389-2092
Provider Business Practice Location Address Fax Number:
507-389-5618
Provider Enumeration Date:
03/08/2006