Provider First Line Business Practice Location Address:
117 N WASHINGTON ST 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:
58203-3450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-740-0634
Provider Business Practice Location Address Fax Number:
701-757-1500
Provider Enumeration Date:
07/28/2006