Provider First Line Business Practice Location Address:
4551 S WASHINGTON ST
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:
58201-3495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-757-7736
Provider Business Practice Location Address Fax Number:
701-757-0496
Provider Enumeration Date:
07/13/2012