Provider First Line Business Practice Location Address:
415 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPSALA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-573-2174
Provider Business Practice Location Address Fax Number:
320-573-2173
Provider Enumeration Date:
08/10/2006