Provider First Line Business Practice Location Address:
1348 15TH AV 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:
701-235-0971
Provider Business Practice Location Address Fax Number:
701-235-1051
Provider Enumeration Date:
04/10/2007