Provider First Line Business Practice Location Address:
509 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGELEY
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-493-2810
Provider Business Practice Location Address Fax Number:
701-493-2641
Provider Enumeration Date:
11/15/2006