Provider First Line Business Practice Location Address:
2605 8TH ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOORHEAD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56560-4203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-291-0242
Provider Business Practice Location Address Fax Number:
218-291-1293
Provider Enumeration Date:
04/11/2009