Provider First Line Business Practice Location Address:
118 N MAIN AVE
Provider Second Line Business Practice Location Address:
BOX 99
Provider Business Practice Location Address City Name:
NEW YORK MILLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-385-5503
Provider Business Practice Location Address Fax Number:
218-385-3852
Provider Enumeration Date:
06/08/2009