Provider First Line Business Practice Location Address:
910 16TH AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAHPETON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-642-1484
Provider Business Practice Location Address Fax Number:
701-642-2883
Provider Enumeration Date:
09/25/2006