Provider First Line Business Practice Location Address:
117 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENDALE
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58436-7101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-349-3390
Provider Business Practice Location Address Fax Number:
701-349-3052
Provider Enumeration Date:
02/16/2007