Provider First Line Business Practice Location Address:
PO BOX 265
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNIFE RIVER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55609-0265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-245-5073
Provider Business Practice Location Address Fax Number:
218-210-9936
Provider Enumeration Date:
01/09/2018