Provider First Line Business Practice Location Address:
2014 7TH ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEMIDJI
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56601-5051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-444-6748
Provider Business Practice Location Address Fax Number:
218-444-8664
Provider Enumeration Date:
01/15/2007