Provider First Line Business Practice Location Address:
1500-24TH AVE. S.W., SUITE 101
Provider Second Line Business Practice Location Address:
HEALTH CENTER-SOUTH RIDGE
Provider Business Practice Location Address City Name:
MINOT
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58701-6905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-242-3778
Provider Business Practice Location Address Fax Number:
618-242-2551
Provider Enumeration Date:
09/06/2007