Provider First Line Business Practice Location Address:
200 NORTH ELM STREET NORTH
Provider Second Line Business Practice Location Address:
MILLE LACS FAMILY CLINIC
Provider Business Practice Location Address City Name:
ONAMIA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-532-3154
Provider Business Practice Location Address Fax Number:
320-532-2359
Provider Enumeration Date:
06/30/2017