Provider First Line Business Practice Location Address:
404 HWY 2 EAST
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:
58301-0130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-662-4085
Provider Business Practice Location Address Fax Number:
701-662-6685
Provider Enumeration Date:
08/27/2007