Provider First Line Business Practice Location Address:
101 4TH ST E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARK RAPIDS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56470-2912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-732-2903
Provider Business Practice Location Address Fax Number:
218-732-6435
Provider Enumeration Date:
04/28/2026