Provider First Line Business Practice Location Address:
502 12TH AVE SE LOT 86
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:
58301-3823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-381-2581
Provider Business Practice Location Address Fax Number:
701-766-1870
Provider Enumeration Date:
10/11/2020