Provider First Line Business Practice Location Address:
805 14TH ST. SO.
Provider Second Line Business Practice Location Address:
MSUM WELLNESS CENTER
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:
320-305-2257
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2012