Provider First Line Business Practice Location Address:
301 AMERICA AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEMIDJI
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56601-3120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-755-5170
Provider Business Practice Location Address Fax Number:
218-751-1194
Provider Enumeration Date:
01/23/2007