Provider First Line Business Practice Location Address:
221 NORTH CENTRAL AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENMARE
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58746-0481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-385-4364
Provider Business Practice Location Address Fax Number:
701-385-4396
Provider Enumeration Date:
07/29/2014