Provider First Line Business Practice Location Address:
725 CENTER AVE
Provider Second Line Business Practice Location Address:
SUITE # 2
Provider Business Practice Location Address City Name:
MOORHEAD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56560-1961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-233-2650
Provider Business Practice Location Address Fax Number:
218-233-2928
Provider Enumeration Date:
01/23/2006