Provider First Line Business Practice Location Address:
1500-24TH AVE. S.W.
Provider Second Line Business Practice Location Address:
HEALTH CENTER - SOUTH RIDGE
Provider Business Practice Location Address City Name:
MINOT
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58701-6905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-857-5343
Provider Business Practice Location Address Fax Number:
701-857-5063
Provider Enumeration Date:
07/31/2006