Provider First Line Business Practice Location Address:
124 COLFAX AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WADENA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56482-1468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-631-2515
Provider Business Practice Location Address Fax Number:
218-632-2517
Provider Enumeration Date:
08/22/2006