Provider First Line Business Practice Location Address:
115 6TH STREET NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASS LAKE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-335-8273
Provider Business Practice Location Address Fax Number:
218-335-8352
Provider Enumeration Date:
03/11/2011