Provider First Line Business Practice Location Address:
112 1ST ST W STE 204-205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEMIDJI
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56601-4002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-670-5239
Provider Business Practice Location Address Fax Number:
218-888-8033
Provider Enumeration Date:
12/02/2008