Provider First Line Business Practice Location Address:
1421 CENTRAL AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
E GRAND FORKS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56721-1617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-773-3010
Provider Business Practice Location Address Fax Number:
218-773-9780
Provider Enumeration Date:
02/07/2008