Provider First Line Business Practice Location Address:
1001 N FIRST AVENUE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-762-3409
Provider Business Practice Location Address Fax Number:
715-762-3073
Provider Enumeration Date:
10/26/2006