Provider First Line Business Practice Location Address:
524 COUNTY ROAD 34 EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DODGE CENTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-858-7427
Provider Business Practice Location Address Fax Number:
920-830-6707
Provider Enumeration Date:
07/28/2005