Provider First Line Business Practice Location Address:
2900 S COLUMBIA RD
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:
58201-6070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-746-6745
Provider Business Practice Location Address Fax Number:
701-746-6961
Provider Enumeration Date:
02/18/2011