Provider First Line Business Practice Location Address:
135 MYERS FIELDHOUSE
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:
56001-6171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-389-3229
Provider Business Practice Location Address Fax Number:
507-389-5352
Provider Enumeration Date:
05/02/2007