Provider First Line Business Practice Location Address:
200 AIRPORT ROAD - OLD DSS BUILDING
Provider Second Line Business Practice Location Address:
EAST HIGHWAY - 18
Provider Business Practice Location Address City Name:
PINE RIDGE
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57770-5011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-867-1704
Provider Business Practice Location Address Fax Number:
605-867-2063
Provider Enumeration Date:
03/06/2009