Provider First Line Business Practice Location Address:
231 CENTENNIAL DR STOP 7189
Provider Second Line Business Practice Location Address:
EDUCATION BUILDING ROOM 200
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58202-7189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-777-2346
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2023