Provider First Line Business Practice Location Address:
1551 28TH AVE S
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58201-6782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-746-4400
Provider Business Practice Location Address Fax Number:
701-746-6034
Provider Enumeration Date:
04/18/2007