Provider First Line Business Practice Location Address:
516 NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATFORD CITY
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-842-3000
Provider Business Practice Location Address Fax Number:
701-842-4503
Provider Enumeration Date:
07/21/2006