Provider First Line Business Practice Location Address:
1000 8TH ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT LAKES
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56501-2819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-847-0696
Provider Business Practice Location Address Fax Number:
218-847-4198
Provider Enumeration Date:
02/07/2008