Provider First Line Business Practice Location Address:
16351 I94
Provider Second Line Business Practice Location Address:
HOME ON THE RANGE
Provider Business Practice Location Address City Name:
SENTINEL BUTTE
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58654-9500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-872-3745
Provider Business Practice Location Address Fax Number:
701-872-3748
Provider Enumeration Date:
03/30/2007