Provider First Line Business Practice Location Address:
107 2ND AVENUE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAMOURE
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-883-5383
Provider Business Practice Location Address Fax Number:
701-883-5113
Provider Enumeration Date:
07/25/2006