Provider First Line Business Practice Location Address:
2121 HIGHWAY 10 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOORHEAD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56560-2559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-236-7076
Provider Business Practice Location Address Fax Number:
218-236-4999
Provider Enumeration Date:
08/07/2006