Provider First Line Business Practice Location Address:
11731 HWY 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHOME
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-897-5275
Provider Business Practice Location Address Fax Number:
218-897-5280
Provider Enumeration Date:
10/19/2006