Provider First Line Business Practice Location Address:
1004 FIRST ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARK RAPIDS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56470-9502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-237-5760
Provider Business Practice Location Address Fax Number:
218-237-5763
Provider Enumeration Date:
12/14/2006