Provider First Line Business Practice Location Address:
1105 3RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INTERNATIONAL FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56649-2955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-283-3425
Provider Business Practice Location Address Fax Number:
218-283-2766
Provider Enumeration Date:
08/31/2006