Provider First Line Business Practice Location Address:
116 1ST AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARSHALL
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58770-0398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-862-3711
Provider Business Practice Location Address Fax Number:
701-862-3705
Provider Enumeration Date:
09/20/2006