Provider First Line Business Practice Location Address:
117 NORTH WASHINGTON STREET
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:
58203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-746-0485
Provider Business Practice Location Address Fax Number:
701-746-3201
Provider Enumeration Date:
11/01/2006