Provider First Line Business Practice Location Address:
1145 SHENANDOAH LANE
Provider Second Line Business Practice Location Address:
ADULT CORRECTIONAL FACILITY, TELESIS
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
FM
Provider Business Practice Location Address Postal Code:
55447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-596-0105
Provider Business Practice Location Address Fax Number:
763-475-4297
Provider Enumeration Date:
01/22/2008