Provider First Line Business Practice Location Address:
249 CENTRAL AVENUE
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:
56347-1337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-732-2002
Provider Business Practice Location Address Fax Number:
320-732-2002
Provider Enumeration Date:
08/18/2006