Provider First Line Business Practice Location Address:
1013 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUBUN
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56589
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-473-6171
Provider Business Practice Location Address Fax Number:
218-473-6191
Provider Enumeration Date:
10/19/2006