Provider First Line Business Practice Location Address:
30 -7TH ST. W, DOOR A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DICKINSON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58601-4335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-483-0230
Provider Business Practice Location Address Fax Number:
701-483-0231
Provider Enumeration Date:
02/27/2006