Provider First Line Business Practice Location Address: 
305 S STATE ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
ABERDEEN
    Provider Business Practice Location Address State Name: 
SD
    Provider Business Practice Location Address Postal Code: 
57401-4527
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
605-622-5000
    Provider Business Practice Location Address Fax Number: 
605-622-5255
    Provider Enumeration Date: 
05/13/2015