Provider First Line Business Practice Location Address:
222 CARPENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BACKUS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56435-2209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-947-3543
Provider Business Practice Location Address Fax Number:
218-947-3549
Provider Enumeration Date:
12/18/2009