Provider First Line Business Practice Location Address:
11 2ND ST SW
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
WADENA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56482-1417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-631-1714
Provider Business Practice Location Address Fax Number:
218-631-4228
Provider Enumeration Date:
05/13/2009