Provider First Line Business Practice Location Address:
810 4TH ST S
Provider Second Line Business Practice Location Address:
SUITE 152
Provider Business Practice Location Address City Name:
MOORHEAD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-287-1500
Provider Business Practice Location Address Fax Number:
218-287-1267
Provider Enumeration Date:
02/07/2008