Provider First Line Business Practice Location Address:
1133 4TH AVE S
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:
54552-1922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-762-4600
Provider Business Practice Location Address Fax Number:
715-762-2835
Provider Enumeration Date:
12/01/2006