Provider First Line Business Practice Location Address:
104 N PARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHWOOD
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58267-4103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-587-6000
Provider Business Practice Location Address Fax Number:
701-587-6009
Provider Enumeration Date:
05/28/2006