Provider First Line Business Practice Location Address:
121 N 3RD ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BISMARCK
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-223-2775
Provider Business Practice Location Address Fax Number:
701-751-0914
Provider Enumeration Date:
06/30/2009