Provider First Line Business Practice Location Address: 
407 E 3RD ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
DULUTH
    Provider Business Practice Location Address State Name: 
MN
    Provider Business Practice Location Address Postal Code: 
55805-1950
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
218-786-4000
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
02/03/2015