Provider First Line Business Practice Location Address:
1008 10TH ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58401-7207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-252-2424
Provider Business Practice Location Address Fax Number:
701-252-3205
Provider Enumeration Date:
09/29/2006