Provider First Line Business Practice Location Address:
315 2ND AVE NW
Provider Second Line Business Practice Location Address:
BOX 787
Provider Business Practice Location Address City Name:
KENMARE
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58746-7160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-385-4941
Provider Business Practice Location Address Fax Number:
701-385-4215
Provider Enumeration Date:
06/30/2014