Provider First Line Business Practice Location Address:
113 MAIN STREET SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATFORD CITY
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58854-2479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-842-6400
Provider Business Practice Location Address Fax Number:
701-842-6403
Provider Enumeration Date:
08/31/2012