Provider First Line Business Practice Location Address:
318 1ST AVE NE
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:
58746-0638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-385-4041
Provider Business Practice Location Address Fax Number:
701-385-4986
Provider Enumeration Date:
10/10/2006