Provider First Line Business Practice Location Address:
4000 24TH AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58201-8863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-787-7500
Provider Business Practice Location Address Fax Number:
701-787-7822
Provider Enumeration Date:
10/03/2006