Provider First Line Business Practice Location Address:
1202 5TH GRANT BLVD
Provider Second Line Business Practice Location Address:
LAKE CITY MEDICAL CENTER
Provider Business Practice Location Address City Name:
WABASHA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55981-1042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-565-4571
Provider Business Practice Location Address Fax Number:
651-565-4818
Provider Enumeration Date:
09/15/2006