Provider First Line Business Practice Location Address:
101 2ND AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARNESVILLE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-354-2299
Provider Business Practice Location Address Fax Number:
218-354-2472
Provider Enumeration Date:
12/11/2006