Provider First Line Business Practice Location Address:
120 LABREE AVENUE SOUTH
Provider Second Line Business Practice Location Address:
NORTHWEST MEDICAL CENTER MENTAL HEALTH DIVISION
Provider Business Practice Location Address City Name:
THIEF RIVER FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-683-4351
Provider Business Practice Location Address Fax Number:
218-683-4362
Provider Enumeration Date:
04/22/2006