Provider First Line Business Practice Location Address:
1245 WASHINGTON AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT LAKES
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-846-2000
Provider Business Practice Location Address Fax Number:
218-846-2114
Provider Enumeration Date:
06/05/2006