Provider First Line Business Practice Location Address:
3222 28TH ST SW
Provider Second Line Business Practice Location Address:
GREAT PLAINS HEALTH COMPANY
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58104-5183
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-232-3000
Provider Business Practice Location Address Fax Number:
701-232-3005
Provider Enumeration Date:
01/23/2007