Provider First Line Business Practice Location Address:
403 4TH ST NW
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BEMIDJI
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56601-3142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-444-5771
Provider Business Practice Location Address Fax Number:
218-444-5985
Provider Enumeration Date:
12/28/2005