Provider First Line Business Practice Location Address:
125 FRAZEE ST E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT LAKES
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56501-3501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-844-2465
Provider Business Practice Location Address Fax Number:
218-844-2479
Provider Enumeration Date:
01/04/2010