Provider First Line Business Practice Location Address:
1616 S 17TH 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:
58201-5355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-795-8550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2007