Provider First Line Business Practice Location Address:
404 HWY 2 E
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:
58301-0130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-662-4085
Provider Business Practice Location Address Fax Number:
701-662-6010
Provider Enumeration Date:
09/29/2006