Provider First Line Business Practice Location Address:
204 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEULAH
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-873-5251
Provider Business Practice Location Address Fax Number:
701-873-2141
Provider Enumeration Date:
08/23/2005