Provider First Line Business Practice Location Address:
515 BRIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARK RAPIDS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56470-1210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-366-9229
Provider Business Practice Location Address Fax Number:
218-237-2520
Provider Enumeration Date:
01/17/2007