Provider First Line Business Practice Location Address:
205 2ND ST S
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:
56347-1353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-732-2194
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2026