Provider First Line Business Practice Location Address:
PHS INDIAN HEALTH SERVICE
Provider Second Line Business Practice Location Address:
40520 CO. HWY 34
Provider Business Practice Location Address City Name:
OGEMA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-983-6375
Provider Business Practice Location Address Fax Number:
218-983-6384
Provider Enumeration Date:
04/03/2007