Provider First Line Business Practice Location Address:
614 DAKOTA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAHPETON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58075-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-642-4471
Provider Business Practice Location Address Fax Number:
701-642-2878
Provider Enumeration Date:
03/25/2008