Provider First Line Business Practice Location Address:
304 4TH ST NE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
DEVILS LAKE
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58301-2480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-662-1331
Provider Business Practice Location Address Fax Number:
701-662-1375
Provider Enumeration Date:
05/03/2017