Provider First Line Business Practice Location Address:
701 HIGHWAY 10 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT LAKES
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56501-4219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-847-9214
Provider Business Practice Location Address Fax Number:
218-847-9215
Provider Enumeration Date:
02/14/2012