Provider First Line Business Practice Location Address:
103 9TH ST N
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:
58075-4311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-642-1913
Provider Business Practice Location Address Fax Number:
701-642-1917
Provider Enumeration Date:
08/31/2005