Provider First Line Business Practice Location Address:
2810 2ND AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOORHEAD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-233-0361
Provider Business Practice Location Address Fax Number:
218-233-8307
Provider Enumeration Date:
02/12/2007