Provider First Line Business Practice Location Address:
705 5TH ST NW STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEMIDJI
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-333-4735
Provider Business Practice Location Address Fax Number:
218-333-4783
Provider Enumeration Date:
05/29/2014