Provider First Line Business Practice Location Address:
330 3RD ST NE
Provider Second Line Business Practice Location Address:
MAYVILLE STATE UIVERSITY
Provider Business Practice Location Address City Name:
MAYVILLE
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58257-1217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-788-4844
Provider Business Practice Location Address Fax Number:
701-788-4840
Provider Enumeration Date:
05/07/2014