Provider First Line Business Practice Location Address:
412 7TH ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEVILS LAKE
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58301-2530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-347-1188
Provider Business Practice Location Address Fax Number:
701-401-5154
Provider Enumeration Date:
01/11/2007