Provider First Line Business Practice Location Address:
1807 WEST HWY 61
Provider Second Line Business Practice Location Address:
P.O. BOX 847
Provider Business Practice Location Address City Name:
GRAND MARAIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55604-0847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-387-9444
Provider Business Practice Location Address Fax Number:
218-387-9435
Provider Enumeration Date:
04/03/2007