Provider First Line Business Practice Location Address:
600 22ND AVE NW
Provider Second Line Business Practice Location Address:
NORTHLAND PROFESSIONAL BUILDING
Provider Business Practice Location Address City Name:
MINOT
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58703-0986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-852-9113
Provider Business Practice Location Address Fax Number:
701-838-0779
Provider Enumeration Date:
05/31/2007