Provider First Line Business Practice Location Address:
517 DAKOTA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAHPETON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-642-9302
Provider Business Practice Location Address Fax Number:
701-642-4321
Provider Enumeration Date:
04/20/2010