Provider First Line Business Practice Location Address:
210 JEFFERSON ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WADENA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56482-1532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-640-2647
Provider Business Practice Location Address Fax Number:
218-461-4558
Provider Enumeration Date:
02/19/2013