Provider First Line Business Practice Location Address:
HOSPITAL ROAD
Provider Second Line Business Practice Location Address:
PINE RIDGE INDIAN RESERVATION
Provider Business Practice Location Address City Name:
PINE RIDGE
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57770-9998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-578-4409
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2006