Provider First Line Business Practice Location Address: 
400 22ND AVE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
BROOKINGS
    Provider Business Practice Location Address State Name: 
SD
    Provider Business Practice Location Address Postal Code: 
57006-2450
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
605-697-9500
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
01/14/2018