Provider First Line Business Practice Location Address:
240 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG PRAIRIE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-732-2313
Provider Business Practice Location Address Fax Number:
320-533-3147
Provider Enumeration Date:
12/21/2018