Provider First Line Business Practice Location Address:
509 BIRCH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PARK FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54552-1416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-762-2449
Provider Business Practice Location Address Fax Number:
715-762-4982
Provider Enumeration Date:
12/12/2006