Provider First Line Business Practice Location Address:
225 N 7TH ST # 2
Provider Second Line Business Practice Location Address:
UNITED BANK BLDG
Provider Business Practice Location Address City Name:
BISMARCK
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58501-4417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-224-1273
Provider Business Practice Location Address Fax Number:
701-323-2929
Provider Enumeration Date:
03/21/2006