Provider First Line Business Practice Location Address:
713 PRENTICE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANITE FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56241-1519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-379-1293
Provider Business Practice Location Address Fax Number:
320-379-1295
Provider Enumeration Date:
12/16/2010