Provider First Line Business Practice Location Address:
STATE DEVELOPMENTAL CENTER, WEST 6TH STREET
Provider Second Line Business Practice Location Address:
GRAFTON VA CLINIC
Provider Business Practice Location Address City Name:
GRAFTON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58237-2036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-352-4059
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2006