Provider First Line Business Practice Location Address:
2845 36 AVE SOUTH
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:
58201-6747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-775-4444
Provider Business Practice Location Address Fax Number:
701-775-4530
Provider Enumeration Date:
11/06/2006