Provider First Line Business Practice Location Address:
621 3RD AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARK FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54552-1235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-820-2566
Provider Business Practice Location Address Fax Number:
715-518-9059
Provider Enumeration Date:
11/29/2006