Provider First Line Business Practice Location Address:
110 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:
56470-1695
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-237-2312
Provider Business Practice Location Address Fax Number:
218-237-2499
Provider Enumeration Date:
04/03/2007