Provider First Line Business Practice Location Address:
CENTRACARE CLINIC ADULT AND PEDIATRIC UROLOGY
Provider Second Line Business Practice Location Address:
2351 CONNECTICUT AVENUE SOUTH #200
Provider Business Practice Location Address City Name:
ST CLOUD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56303-2477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-259-1411
Provider Business Practice Location Address Fax Number:
320-259-8967
Provider Enumeration Date:
08/01/2012