Provider First Line Business Practice Location Address:
1400 HIGHWAY 71
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INTERNATIONAL FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56649-2154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-283-4481
Provider Business Practice Location Address Fax Number:
218-283-2281
Provider Enumeration Date:
11/28/2005