Provider First Line Business Practice Location Address:
2921 6TH 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:
56560-2594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-359-9000
Provider Business Practice Location Address Fax Number:
218-359-0491
Provider Enumeration Date:
10/17/2006