Provider First Line Business Practice Location Address:
416 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASS LAKE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-335-8868
Provider Business Practice Location Address Fax Number:
218-335-8147
Provider Enumeration Date:
09/08/2008