Provider First Line Business Practice Location Address:
2720 17TH 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:
58201-4008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-772-6922
Provider Business Practice Location Address Fax Number:
701-746-8080
Provider Enumeration Date:
10/22/2019