Provider First Line Business Practice Location Address:
413 13TH AVE
Provider Second Line Business Practice Location Address:
HOWARD LAKE GOOD SAMARITAN CTR
Provider Business Practice Location Address City Name:
HOWARD LAKE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55349-0316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-543-0171
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2008