Provider First Line Business Practice Location Address:
HIGHWAY 18 EAST
Provider Second Line Business Practice Location Address:
PINE RIDGE HOSPITAL - INDIAN HEALTH SERVICE UNIT
Provider Business Practice Location Address City Name:
PINE RIDGE
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-867-3273
Provider Business Practice Location Address Fax Number:
605-867-3271
Provider Enumeration Date:
12/22/2005