Individual
MR. LARRY BRACKENBURY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
810 8TH ST SW, PINE CITY, MN 55063-2037
(320) 629-3730
Mailing address
810 8TH ST SW, PINE CITY, MN 55063-2037
(320) 629-3730
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
05/11/2012
Last updated
05/11/2012
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