Provider First Line Business Practice Location Address:
310 4TH ST NW
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-662-8980
Provider Business Practice Location Address Fax Number:
701-662-8504
Provider Enumeration Date:
09/14/2011