Provider First Line Business Practice Location Address:
523 3RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INTERNATIONAL FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56649-2421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-238-2010
Provider Business Practice Location Address Fax Number:
218-283-2011
Provider Enumeration Date:
11/02/2005