Provider First Line Business Practice Location Address:
3221 32ND AVE S
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:
58201-6071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-780-9701
Provider Business Practice Location Address Fax Number:
701-780-9084
Provider Enumeration Date:
06/04/2010