Provider First Line Business Practice Location Address:
18 MAIN STREET NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK MILLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56567-0149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-385-3859
Provider Business Practice Location Address Fax Number:
218-385-3859
Provider Enumeration Date:
11/15/2006