Provider First Line Business Practice Location Address:
210 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENDALE
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58436-0310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-349-3636
Provider Business Practice Location Address Fax Number:
701-349-2137
Provider Enumeration Date:
05/10/2007