Provider First Line Business Practice Location Address:
309 1ST AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENMARE
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-385-4283
Provider Business Practice Location Address Fax Number:
701-385-4282
Provider Enumeration Date:
07/17/2009