Provider First Line Business Practice Location Address: 
3015 3RD AVE SE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
ABERDEEN
    Provider Business Practice Location Address State Name: 
SD
    Provider Business Practice Location Address Postal Code: 
57401-5418
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
605-725-1700
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
05/03/2006