Provider First Line Business Practice Location Address:
920 10TH ST SE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58401-5819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-252-9852
Provider Business Practice Location Address Fax Number:
701-952-9853
Provider Enumeration Date:
05/18/2006