Provider First Line Business Practice Location Address:
1002 WASHINGTON AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEMIDJI
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56601-3453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-444-8090
Provider Business Practice Location Address Fax Number:
218-333-9434
Provider Enumeration Date:
08/04/2020