Provider First Line Business Practice Location Address:
1360 ELM STREET EAST
Provider Second Line Business Practice Location Address:
CENTRACARE CLINIC
Provider Business Practice Location Address City Name:
ST JOSEPH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56374-4694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-363-7765
Provider Business Practice Location Address Fax Number:
320-363-0031
Provider Enumeration Date:
01/11/2006