Provider First Line Business Practice Location Address:
1405 ANNE ST NW
Provider Second Line Business Practice Location Address:
C/O NORTHERN DENTAL ACCESS CENTER
Provider Business Practice Location Address City Name:
BEMIDJI
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56601-5113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-444-9646
Provider Business Practice Location Address Fax Number:
218-444-9252
Provider Enumeration Date:
04/20/2009