Provider First Line Business Practice Location Address: 
904 W 23RD ST; STE 101
    Provider Second Line Business Practice Location Address: 
HEARTLAND PSYCHOLOGICAL SERVICES
    Provider Business Practice Location Address City Name: 
YANKTON
    Provider Business Practice Location Address State Name: 
SD
    Provider Business Practice Location Address Postal Code: 
57078-1206
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
605-665-0841
    Provider Business Practice Location Address Fax Number: 
605-665-0096
    Provider Enumeration Date: 
08/19/2011