Provider First Line Business Practice Location Address:
45650 265TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBOLDT
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57035-6813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-336-3230
Provider Business Practice Location Address Fax Number:
605-861-6913
Provider Enumeration Date:
12/18/2025