Provider First Line Business Practice Location Address:
2422 20TH ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58401-6201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-252-1050
Provider Business Practice Location Address Fax Number:
701-952-3265
Provider Enumeration Date:
05/20/2006