Provider First Line Business Practice Location Address:
347 NORTH SMITH AVENUE
Provider Second Line Business Practice Location Address:
CHILDREN'S SPECIALTY CLINIC PSYCHOLOGICAL SERVICES STPL
Provider Business Practice Location Address City Name:
ST. PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-220-6720
Provider Business Practice Location Address Fax Number:
651-220-6707
Provider Enumeration Date:
05/03/2006