Provider First Line Business Practice Location Address:
4401 S 11TH STREET; STE 1000 - SANNY & JERRY RYAN CENTE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-732-7620
Provider Business Practice Location Address Fax Number:
701-738-0055
Provider Enumeration Date:
07/09/2006