Provider First Line Business Practice Location Address:
244 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG PRAIRIE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-732-3228
Provider Business Practice Location Address Fax Number:
320-732-7102
Provider Enumeration Date:
06/17/2010