Provider First Line Business Practice Location Address:
1015 S. BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 20
Provider Business Practice Location Address City Name:
MINOT
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-838-1123
Provider Business Practice Location Address Fax Number:
701-838-1261
Provider Enumeration Date:
01/23/2012