Provider First Line Business Practice Location Address:
1107 7TH ST. S.
Provider Second Line Business Practice Location Address:
MSU MOORHEAD - ATHLETICS
Provider Business Practice Location Address City Name:
MOORHEAD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-477-2626
Provider Business Practice Location Address Fax Number:
218-477-5943
Provider Enumeration Date:
06/28/2006