Provider First Line Business Practice Location Address:
200 HWY 2 WEST
Provider Second Line Business Practice Location Address:
LAKE REGION HUMAN SERVICE CENTER
Provider Business Practice Location Address City Name:
DEVILS LAKE
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58301-0650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-665-2200
Provider Business Practice Location Address Fax Number:
701-665-2300
Provider Enumeration Date:
12/06/2012