Provider First Line Business Practice Location Address:
209 2ND STREET SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALLEY CITY
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-845-1124
Provider Business Practice Location Address Fax Number:
701-845-1175
Provider Enumeration Date:
11/22/2006