Provider First Line Business Practice Location Address:
2625 24TH AVE S
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58201-6180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-746-7979
Provider Business Practice Location Address Fax Number:
701-746-9758
Provider Enumeration Date:
06/22/2009