Provider First Line Business Practice Location Address:
105 S MAIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANKINSON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-242-7255
Provider Business Practice Location Address Fax Number:
701-242-7497
Provider Enumeration Date:
11/20/2006