Provider First Line Business Practice Location Address:
209 1ST ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARK RAPIDS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56470-1504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-732-0836
Provider Business Practice Location Address Fax Number:
218-732-0865
Provider Enumeration Date:
11/15/2006