Provider First Line Business Practice Location Address:
1424 HIGHWAY 2 E
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:
58301-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-662-2170
Provider Business Practice Location Address Fax Number:
701-662-2531
Provider Enumeration Date:
03/26/2014