Provider First Line Business Practice Location Address:
10012 50K ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEFOR
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58641-9263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-885-0371
Provider Business Practice Location Address Fax Number:
701-299-6556
Provider Enumeration Date:
12/09/2025