Provider First Line Business Practice Location Address:
1426 BEMIDJI AVE N STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEMIDJI
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56601-3882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-333-8811
Provider Business Practice Location Address Fax Number:
218-333-8813
Provider Enumeration Date:
03/01/2007