Provider First Line Business Practice Location Address:
2205 2ND AVE. WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INT'L. FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56649-3933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-283-9000
Provider Business Practice Location Address Fax Number:
218-283-9002
Provider Enumeration Date:
06/29/2006