Provider First Line Business Practice Location Address:
122 EAST 2ND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCCLUSKY
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58463-0618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-363-2296
Provider Business Practice Location Address Fax Number:
701-363-2762
Provider Enumeration Date:
06/13/2017