Provider First Line Business Practice Location Address:
125 EDWARDS AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED LAKE FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56750-4019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-253-4131
Provider Business Practice Location Address Fax Number:
218-253-2926
Provider Enumeration Date:
06/01/2011