Provider First Line Business Practice Location Address:
212 SOUTH 4TH STREET
Provider Second Line Business Practice Location Address:
SUITE 101
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-412-3600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2006