Provider First Line Business Practice Location Address:
600 E HARVEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55731-1614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-365-6166
Provider Business Practice Location Address Fax Number:
218-365-6138
Provider Enumeration Date:
12/26/2006