Provider First Line Business Practice Location Address:
1110 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHEATLAND
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58079-4008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-361-4253
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2026