Provider First Line Business Practice Location Address:
1451 - 44TH AVENUE SOUTH SUITE 112-D
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:
58201-4055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-795-1300
Provider Business Practice Location Address Fax Number:
701-775-5200
Provider Enumeration Date:
08/25/2005