Provider First Line Business Practice Location Address:
7579 HIGHWAY 2
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:
58301-8805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-230-2402
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2023