Provider First Line Business Practice Location Address:
832 8TH ST N
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:
58075-3642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-642-3796
Provider Business Practice Location Address Fax Number:
701-642-1984
Provider Enumeration Date:
01/20/2009