Provider First Line Business Practice Location Address:
1322 THIRD STREET
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
INTERNATIONAL FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-283-2243
Provider Business Practice Location Address Fax Number:
218-285-3608
Provider Enumeration Date:
10/04/2006