Provider First Line Business Practice Location Address:
1005 SOUTH MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATFORD CITY
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-444-3221
Provider Business Practice Location Address Fax Number:
701-444-2448
Provider Enumeration Date:
12/20/2005