Provider First Line Business Practice Location Address:
1100 38TH ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEMIDJI
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56601-5107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-751-5430
Provider Business Practice Location Address Fax Number:
218-759-5880
Provider Enumeration Date:
02/22/2008