Provider First Line Business Practice Location Address:
211 EAST MILL STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PELICAN RAPIDS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56572-0737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-863-6100
Provider Business Practice Location Address Fax Number:
218-863-6173
Provider Enumeration Date:
09/13/2007