Provider First Line Business Practice Location Address:
24760 HOSPITAL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED LAKE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56671-0249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-679-3316
Provider Business Practice Location Address Fax Number:
218-679-3990
Provider Enumeration Date:
01/06/2009