Provider First Line Business Practice Location Address: 
750 E 34TH ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
HIBBING
    Provider Business Practice Location Address State Name: 
MN
    Provider Business Practice Location Address Postal Code: 
55746-2341
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
218-362-6811
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/26/2010