Provider First Line Business Practice Location Address:
3035 DEMERS AVE
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:
58201-4018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-775-3151
Provider Business Practice Location Address Fax Number:
701-775-3153
Provider Enumeration Date:
06/27/2005