Provider First Line Business Practice Location Address:
503 3RD ST NE
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:
58301-3015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-662-4961
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2007