Provider First Line Business Practice Location Address:
1820 WALNUT ST E
Provider Second Line Business Practice Location Address:
SUITE #7
Provider Business Practice Location Address City Name:
DEVILS LAKE
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58301-3411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-665-2140
Provider Business Practice Location Address Fax Number:
701-665-2153
Provider Enumeration Date:
08/04/2008