Provider First Line Business Practice Location Address:
1233 HIGHWAY 10 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOTLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56466-8209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-352-6922
Provider Business Practice Location Address Fax Number:
218-898-7594
Provider Enumeration Date:
10/28/2005