Provider First Line Business Practice Location Address:
923 6TH AVE 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:
58301-2210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-662-8681
Provider Business Practice Location Address Fax Number:
701-662-5776
Provider Enumeration Date:
12/28/2006