Provider First Line Business Practice Location Address:
7332 HIGHWAY 19
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:
58301-8835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-393-4461
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/18/2020