Provider First Line Business Practice Location Address:
1200 SIXTH AVE N
Provider Second Line Business Practice Location Address:
CENTRA CARE CLINIC
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-251-0726
Provider Business Practice Location Address Fax Number:
302-229-5188
Provider Enumeration Date:
03/09/2006