Provider First Line Business Practice Location Address:
1101 LINDEN LN
Provider Second Line Business Practice Location Address:
MINNESOTA CORRECTIONAL FACILITY FARIBAULT HEALTH SVCS
Provider Business Practice Location Address City Name:
FARIBAULT
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55021-6400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-334-0774
Provider Business Practice Location Address Fax Number:
507-334-0730
Provider Enumeration Date:
04/13/2007