Provider First Line Business Practice Location Address:
206 1ST ST SE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-631-4431
Provider Business Practice Location Address Fax Number:
218-631-2926
Provider Enumeration Date:
10/23/2006