Provider First Line Business Practice Location Address:
1606 HWY 11-71
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INTERNATIONAL FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-283-3246
Provider Business Practice Location Address Fax Number:
218-283-4617
Provider Enumeration Date:
10/03/2013