Provider First Line Business Practice Location Address:
604 NE 1ST ST
Provider Second Line Business Practice Location Address:
BIRCHWOOD HEALTH CARE CENTER
Provider Business Practice Location Address City Name:
FOREST LAKE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-464-5600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2007