Provider First Line Business Practice Location Address:
612 5TH 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:
56601-2915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-444-4444
Provider Business Practice Location Address Fax Number:
218-444-5103
Provider Enumeration Date:
09/14/2007