Provider First Line Business Practice Location Address:
2144 COUNTY RD 12 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-458-4315
Provider Business Practice Location Address Fax Number:
763-542-2280
Provider Enumeration Date:
04/11/2008