Provider First Line Business Practice Location Address:
1104 7TH AVE S.
Provider Second Line Business Practice Location Address:
BOX 92 MSUM HENDRIX CLINIC & COUNSELING CENTER
Provider Business Practice Location Address City Name:
MOORHEAD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-477-2211
Provider Business Practice Location Address Fax Number:
218-477-5867
Provider Enumeration Date:
02/21/2007