Provider First Line Business Practice Location Address:
1200 W UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
BOX 912
Provider Business Practice Location Address City Name:
MITCHELL
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57301-4358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-995-2145
Provider Business Practice Location Address Fax Number:
605-995-2143
Provider Enumeration Date:
05/11/2006