Provider First Line Business Practice Location Address:
1600 1ST ST E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THIEF RIVER FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56701-2404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-681-1700
Provider Business Practice Location Address Fax Number:
218-681-1718
Provider Enumeration Date:
09/27/2006