Provider First Line Business Practice Location Address:
33 S 3RD ST STE D
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:
58201-4789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-636-3060
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2026