Provider First Line Business Practice Location Address:
616 AMERICA AVE NW
Provider Second Line Business Practice Location Address:
SUITE #130
Provider Business Practice Location Address City Name:
BEMIDJI
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56601-3818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-333-8152
Provider Business Practice Location Address Fax Number:
218-333-8160
Provider Enumeration Date:
09/30/2009