Provider First Line Business Practice Location Address:
E. HWAY 18
Provider Second Line Business Practice Location Address:
IHS HOSPITAL
Provider Business Practice Location Address City Name:
PINE RIDGE
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57770-1201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-350-4647
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2006