Provider First Line Business Practice Location Address:
215 NORTH BENTON DR
Provider Second Line Business Practice Location Address:
INDEPENDENT LIFESTYLES INC.
Provider Business Practice Location Address City Name:
SAUK RAPIDS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-529-9000
Provider Business Practice Location Address Fax Number:
320-529-0747
Provider Enumeration Date:
06/17/2011