Provider First Line Business Practice Location Address:
562 1/2 12TH ST. W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DICKINSON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58601-3509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-483-8824
Provider Business Practice Location Address Fax Number:
701-483-1443
Provider Enumeration Date:
11/03/2006