Provider First Line Business Practice Location Address:
1415 1ST ST E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARK RAPIDS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56470-1803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-237-5464
Provider Business Practice Location Address Fax Number:
218-237-5541
Provider Enumeration Date:
06/17/2005