Provider First Line Business Practice Location Address:
12 5TH AVE. NE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-863-2134
Provider Business Practice Location Address Fax Number:
218-863-2135
Provider Enumeration Date:
08/20/2006