Provider First Line Business Practice Location Address:
1999 4TH ST N
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
WAHPETON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58075-3422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-642-2656
Provider Business Practice Location Address Fax Number:
701-642-2657
Provider Enumeration Date:
08/21/2006