Provider First Line Business Practice Location Address:
440 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INTERNATIONAL FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56649-2414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-285-7428
Provider Business Practice Location Address Fax Number:
218-285-7429
Provider Enumeration Date:
09/14/2006