Provider First Line Business Practice Location Address:
180 HIGHWAY 10 N
Provider Second Line Business Practice Location Address:
BOX 86
Provider Business Practice Location Address City Name:
MOTLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56466-9055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-352-6753
Provider Business Practice Location Address Fax Number:
218-352-8309
Provider Enumeration Date:
11/03/2005