Provider First Line Business Practice Location Address:
401 COLLEGE DR S
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:
58301-3501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-662-3117
Provider Business Practice Location Address Fax Number:
701-662-2055
Provider Enumeration Date:
10/30/2015