Provider First Line Business Practice Location Address:
194 MISSILE AVENUE
Provider Second Line Business Practice Location Address:
MINOT AFB - 5 MDG MENTAL HEALTH CLINIC
Provider Business Practice Location Address City Name:
MINOT
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-723-5527
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2009