Provider First Line Business Practice Location Address:
212 S 4TH ST STE 200
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:
58201-4781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-498-7191
Provider Business Practice Location Address Fax Number:
406-723-3059
Provider Enumeration Date:
09/29/2006