Provider First Line Business Practice Location Address:
509 2ND ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGELEY
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58433-0074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-493-2231
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2006