Provider First Line Business Practice Location Address:
408 S. JOHNSTON ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE LAKE
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-249-2216
Provider Business Practice Location Address Fax Number:
605-249-2599
Provider Enumeration Date:
06/22/2006