Provider First Line Business Practice Location Address:
324 1ST ST NW LOT 33
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENDALE
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58436-7421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-535-1582
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2022