Provider First Line Business Practice Location Address:
67 FIRST STREET SE
Provider Second Line Business Practice Location Address:
BOX 279
Provider Business Practice Location Address City Name:
BEACH
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58621-0279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-872-4121
Provider Business Practice Location Address Fax Number:
701-872-3141
Provider Enumeration Date:
06/04/2007