Provider First Line Business Practice Location Address:
250 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG PRAIRIE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56347-1303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-732-2536
Provider Business Practice Location Address Fax Number:
320-732-3672
Provider Enumeration Date:
05/13/2009