Provider First Line Business Practice Location Address:
113 5TH ST S
Provider Second Line Business Practice Location Address:
BOX 287
Provider Business Practice Location Address City Name:
ANETA
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58212-4226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-326-4234
Provider Business Practice Location Address Fax Number:
701-326-4529
Provider Enumeration Date:
10/17/2006