Provider First Line Business Practice Location Address:
3625 5TH ST STE 202
Provider Second Line Business Practice Location Address:
MOUNTAINSIDE FAMILY PRACTICE
Provider Business Practice Location Address City Name:
RAPID CITY
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57701-6002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-348-2636
Provider Business Practice Location Address Fax Number:
605-716-0172
Provider Enumeration Date:
01/25/2006