Provider First Line Business Practice Location Address:
701 1ST AVE. S.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-252-0569
Provider Business Practice Location Address Fax Number:
701-252-0569
Provider Enumeration Date:
10/04/2006