Provider First Line Business Practice Location Address: 
1095 HIGHWAY 15 S
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
HUTCHINSON
    Provider Business Practice Location Address State Name: 
MN
    Provider Business Practice Location Address Postal Code: 
55350
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
320-234-5000
    Provider Business Practice Location Address Fax Number: 
320-484-4686
    Provider Enumeration Date: 
05/05/2006