Provider First Line Business Practice Location Address:
4399 88TH AVE 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:
58301-8704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-398-3031
Provider Business Practice Location Address Fax Number:
701-398-3029
Provider Enumeration Date:
03/29/2010