Provider First Line Business Practice Location Address:
BRAINERD VA COMMUNITY BASED OUTPATIENT CLINIC
Provider Second Line Business Practice Location Address:
722 NW 7TH STREET
Provider Business Practice Location Address City Name:
BRAINERD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-407-4799
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2006