Provider First Line Business Practice Location Address:
1223 14TH ST NW LOT 46
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:
58301-4203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-351-7369
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2020