Provider First Line Business Practice Location Address:
16422 121ST AVE
Provider Second Line Business Practice Location Address:
N/A
Provider Business Practice Location Address City Name:
WADENA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-639-2958
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2026