Provider First Line Business Practice Location Address:
303 LAKOTA AVE
Provider Second Line Business Practice Location Address:
303 LAKOTA AVE
Provider Business Practice Location Address City Name:
CENTER
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-301-2420
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/23/2026