Provider First Line Business Practice Location Address:
2812 17TH AVE S STE C
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:
58201-4048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-775-0223
Provider Business Practice Location Address Fax Number:
701-738-0655
Provider Enumeration Date:
01/18/2007