Provider First Line Business Practice Location Address:
402 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58203-3500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-738-0990
Provider Business Practice Location Address Fax Number:
701-738-0991
Provider Enumeration Date:
03/16/2009