Provider First Line Business Practice Location Address:
211 4TH ST NE
Provider Second Line Business Practice Location Address:
STE 4
Provider Business Practice Location Address City Name:
DEVILS LAKE
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58301-2479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-662-8255
Provider Business Practice Location Address Fax Number:
701-662-1739
Provider Enumeration Date:
08/07/2007