Provider First Line Business Practice Location Address:
200 4TH AVENUE SOUTH
Provider Second Line Business Practice Location Address:
SUITE 121
Provider Business Practice Location Address City Name:
LETHBRIDGE
Provider Business Practice Location Address State Name:
ALBERTA
Provider Business Practice Location Address Postal Code:
T1J4C9
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
587-425-1600
Provider Business Practice Location Address Fax Number:
587-425-1601
Provider Enumeration Date:
11/26/2008