Provider First Line Business Practice Location Address:
1900 CENTRACARE CIRCLE #1300
Provider Second Line Business Practice Location Address:
CENTRACARE CLINIC HEALTH PLAZA PEDIATRIC/ADOLESCENT MED
Provider Business Practice Location Address City Name:
ST CLOUD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56303-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-229-3610
Provider Business Practice Location Address Fax Number:
320-229-3647
Provider Enumeration Date:
12/04/2006