Individual
MR. PATRICK LEE RUDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1112 14TH AVE SE, SAINT CLOUD, MN 56304-1742
(320) 237-4291
Mailing address
1112 14TH AVE SE, SAINT CLOUD, MN 56304-1742
(320) 237-4291
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
—
—
Other
Enumeration date
12/10/2010
Last updated
12/10/2010
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