Provider First Line Business Practice Location Address:
117 2ND ST WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKOTA
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-247-2226
Provider Business Practice Location Address Fax Number:
701-247-2266
Provider Enumeration Date:
12/21/2006