Provider First Line Business Practice Location Address:
4810 WOLF CREEK RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEMIDJI
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56601-7990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-586-2130
Provider Business Practice Location Address Fax Number:
218-586-2165
Provider Enumeration Date:
06/08/2006