Provider First Line Business Practice Location Address:
705 WASHINGTON AVE S
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:
56601-4838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-444-2070
Provider Business Practice Location Address Fax Number:
218-444-8091
Provider Enumeration Date:
05/08/2012