Provider First Line Business Practice Location Address:
1210 13TH AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-952-1253
Provider Business Practice Location Address Fax Number:
701-952-1254
Provider Enumeration Date:
09/07/2007