Provider First Line Business Practice Location Address:
1333 4TH AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARK FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54552-1926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-762-4764
Provider Business Practice Location Address Fax Number:
715-762-4934
Provider Enumeration Date:
05/19/2006