Provider First Line Business Practice Location Address:
240 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENDALE
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-349-3666
Provider Business Practice Location Address Fax Number:
701-349-4945
Provider Enumeration Date:
11/13/2006