Provider First Line Business Practice Location Address:
1102 CTY RD 22 RED PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHBURN
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58577-0186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-462-3531
Provider Business Practice Location Address Fax Number:
701-462-3620
Provider Enumeration Date:
05/16/2007