Provider First Line Business Practice Location Address:
217 GRANDVIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEVILS LAKE
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58301-4123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-662-5590
Provider Business Practice Location Address Fax Number:
701-665-3252
Provider Enumeration Date:
04/21/2006