Provider First Line Business Practice Location Address:
58 MAIN AVE SOUTH
Provider Second Line Business Practice Location Address:
STE 186
Provider Business Practice Location Address City Name:
FESSENDEN
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58438-0186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-547-3201
Provider Business Practice Location Address Fax Number:
701-547-3202
Provider Enumeration Date:
02/12/2007