Provider First Line Business Practice Location Address:
9 SOUTH CENTENNIAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WISHEK
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-452-2368
Provider Business Practice Location Address Fax Number:
701-452-2368
Provider Enumeration Date:
12/15/2006