Provider First Line Business Practice Location Address:
315 MAIN ST W
Provider Second Line Business Practice Location Address:
LAPORTE SCHOOL DISTRICT #306
Provider Business Practice Location Address City Name:
LAPORTE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56461-4659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-444-2845
Provider Business Practice Location Address Fax Number:
218-444-2847
Provider Enumeration Date:
11/03/2006