Provider First Line Business Practice Location Address:
387 11TH ST S OFC 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAHPETON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58075-4677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-642-2336
Provider Business Practice Location Address Fax Number:
701-642-1470
Provider Enumeration Date:
04/25/2013