Provider First Line Business Practice Location Address:
1309 2ND AVE N
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:
58203-3414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-775-3965
Provider Business Practice Location Address Fax Number:
701-775-0121
Provider Enumeration Date:
11/20/2006