Provider First Line Business Practice Location Address:
211 FOUNDERS PARK DRIVE SUITE 3
Provider Second Line Business Practice Location Address:
FOUNDERS PARK CLINIC
Provider Business Practice Location Address City Name:
RAPID CITY
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-791-5959
Provider Business Practice Location Address Fax Number:
605-791-5960
Provider Enumeration Date:
06/30/2006