Provider First Line Business Practice Location Address:
28579 US HIGHWAY 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT LAKES
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56501-7308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-844-5191
Provider Business Practice Location Address Fax Number:
218-844-5193
Provider Enumeration Date:
09/10/2008