Provider First Line Business Practice Location Address:
2123 ST HWY 87NW
Provider Second Line Business Practice Location Address:
SCENIC FOSTER CARE
Provider Business Practice Location Address City Name:
BACKUS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-947-3989
Provider Business Practice Location Address Fax Number:
218-947-3279
Provider Enumeration Date:
12/15/2011