Provider First Line Business Practice Location Address:
1125 6TH STREET SE
Provider Second Line Business Practice Location Address:
WOODLAND CENTERS
Provider Business Practice Location Address City Name:
WILLMAR
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56201-4675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-231-9148
Provider Business Practice Location Address Fax Number:
320-231-9140
Provider Enumeration Date:
12/11/2006