Provider First Line Business Practice Location Address:
HWY 1 HOSPITAL DR
Provider Second Line Business Practice Location Address:
BOX 497
Provider Business Practice Location Address City Name:
RED LAKE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56671-0497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-679-3912
Provider Business Practice Location Address Fax Number:
218-679-0181
Provider Enumeration Date:
06/14/2006