Provider First Line Business Practice Location Address:
306 15TH ST NE
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:
58301-1606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-330-0953
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2026