Provider First Line Business Practice Location Address:
1312 17TH ST
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:
56649-6810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-373-0155
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2026