Provider First Line Business Practice Location Address: 
425 SOUTH 7TH ST
    Provider Second Line Business Practice Location Address: 
SOUTHRIDGE CHIROPRACTIC
    Provider Business Practice Location Address City Name: 
BISMARCK
    Provider Business Practice Location Address State Name: 
ND
    Provider Business Practice Location Address Postal Code: 
58501
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
701-258-8388
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
04/20/2016