Provider First Line Business Practice Location Address:
RT 1 BOX 1A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARRETT
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-528-2650
Provider Business Practice Location Address Fax Number:
320-528-2279
Provider Enumeration Date:
11/15/2006