Provider First Line Business Practice Location Address:
211 FRAZEE STREET EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT LAKES
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-847-3537
Provider Business Practice Location Address Fax Number:
218-847-4405
Provider Enumeration Date:
07/05/2006