Provider First Line Business Practice Location Address:
138 2ND AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARK FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54552-1214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-762-3283
Provider Business Practice Location Address Fax Number:
715-762-2980
Provider Enumeration Date:
01/23/2008