Provider First Line Business Practice Location Address:
1120 KIRBY DR
Provider Second Line Business Practice Location Address:
103 KIRBY STUDENT CENTER
Provider Business Practice Location Address City Name:
DULUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55812-3085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-726-6757
Provider Business Practice Location Address Fax Number:
218-726-6751
Provider Enumeration Date:
07/20/2006