Provider First Line Business Practice Location Address:
110 7TH STREET W
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:
56470-1541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-732-1000
Provider Business Practice Location Address Fax Number:
218-732-4598
Provider Enumeration Date:
04/19/2013