Provider First Line Business Practice Location Address:
550 E 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND MARAIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55604-3105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-387-9322
Provider Business Practice Location Address Fax Number:
218-387-9344
Provider Enumeration Date:
01/30/2012