Provider First Line Business Practice Location Address:
275 11TH ST S
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:
58075-4655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-642-2000
Provider Business Practice Location Address Fax Number:
701-671-4106
Provider Enumeration Date:
05/12/2006