Provider First Line Business Practice Location Address:
709 DAKOTA AVE STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAHPETON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58075-4333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-404-0997
Provider Business Practice Location Address Fax Number:
701-566-8876
Provider Enumeration Date:
06/17/2024