Provider First Line Business Practice Location Address:
308 4TH AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAZA
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58771-0057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-497-3766
Provider Business Practice Location Address Fax Number:
701-497-3779
Provider Enumeration Date:
02/16/2011