Provider First Line Business Practice Location Address:
25519 STATE HIGHWAY 224
Provider Second Line Business Practice Location Address:
PHS INDIAN HEALTH CENTER
Provider Business Practice Location Address City Name:
OGEMA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56569-9506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-983-6374
Provider Business Practice Location Address Fax Number:
218-983-6384
Provider Enumeration Date:
08/26/2005