Provider First Line Business Practice Location Address:
28 2ND ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENMARE
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58746-7114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-385-4004
Provider Business Practice Location Address Fax Number:
701-385-4005
Provider Enumeration Date:
08/28/2019