Provider First Line Business Practice Location Address:
210 1ST ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERTHA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56437-1218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-924-2250
Provider Business Practice Location Address Fax Number:
218-924-2257
Provider Enumeration Date:
09/27/2005