Provider First Line Business Practice Location Address: 
MEDCENTER ONE PHARMACY
    Provider Second Line Business Practice Location Address: 
300 N 7TH ST BOX 5525
    Provider Business Practice Location Address City Name: 
BISMARCK
    Provider Business Practice Location Address State Name: 
ND
    Provider Business Practice Location Address Postal Code: 
58506-5525
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
701-323-8606
    Provider Business Practice Location Address Fax Number: 
701-323-6988
    Provider Enumeration Date: 
06/15/2006