Provider First Line Business Practice Location Address:
915 21ST ST NW
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:
56601-4443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-444-5878
Provider Business Practice Location Address Fax Number:
218-444-5114
Provider Enumeration Date:
03/17/2010