Provider First Line Business Practice Location Address:
1632 BEMIDJI AVE N
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
BEMIDJI
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56601-3870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-444-9918
Provider Business Practice Location Address Fax Number:
218-444-9784
Provider Enumeration Date:
02/26/2007