Provider First Line Business Practice Location Address:
2925 20TH 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-284-0300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2007