Provider First Line Business Practice Location Address:
4570 COUNTY HIGHWAY 61
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOOSE LAKE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-644-0910
Provider Business Practice Location Address Fax Number:
218-644-0911
Provider Enumeration Date:
03/20/2020