Provider First Line Business Practice Location Address:
HIGHWAY 18 E
Provider Second Line Business Practice Location Address:
PINE RIDGE HOSPITAL
Provider Business Practice Location Address City Name:
PINE RIDGE
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57770-1201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-867-3151
Provider Business Practice Location Address Fax Number:
605-867-3306
Provider Enumeration Date:
02/16/2006