Provider First Line Business Practice Location Address:
CBOC BISMARCK
Provider Second Line Business Practice Location Address:
GATEWAY MALL 2700 STATE ST.
Provider Business Practice Location Address City Name:
BISMARCK
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-221-9152
Provider Business Practice Location Address Fax Number:
701-221-0918
Provider Enumeration Date:
11/08/2006