Provider First Line Business Practice Location Address:
213 3RD AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEFIELD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56150-1123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-662-5358
Provider Business Practice Location Address Fax Number:
507-662-5108
Provider Enumeration Date:
12/07/2005