Provider First Line Business Practice Location Address:
1001 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-662-4427
Provider Business Practice Location Address Fax Number:
701-662-1816
Provider Enumeration Date:
10/03/2006