Provider First Line Business Practice Location Address:
120 LABREE AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THIEF RIVER FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56701-2840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-681-4240
Provider Business Practice Location Address Fax Number:
218-683-4632
Provider Enumeration Date:
12/30/2008