Provider First Line Business Practice Location Address:
1200 ROBERTS AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COOPERSTOWN
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58425-7101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-797-2221
Provider Business Practice Location Address Fax Number:
701-797-2457
Provider Enumeration Date:
08/29/2006