Provider First Line Business Practice Location Address:
212 3RD ST NW
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:
56601-3112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-751-8313
Provider Business Practice Location Address Fax Number:
218-444-3385
Provider Enumeration Date:
07/03/2006