Provider First Line Business Practice Location Address:
21 WEST HIGHWAY 61
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND MARAIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-387-1133
Provider Business Practice Location Address Fax Number:
218-387-2169
Provider Enumeration Date:
12/19/2006