Provider First Line Business Practice Location Address:
200 HIGHWAY 2 W
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:
58301-3532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
709-166-5220
Provider Business Practice Location Address Fax Number:
701-665-2300
Provider Enumeration Date:
09/22/2006