Provider First Line Business Practice Location Address:
1700 E INTERSTATE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BISMARCK
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58503-1207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-222-4746
Provider Business Practice Location Address Fax Number:
701-222-1783
Provider Enumeration Date:
10/24/2006