Provider First Line Business Practice Location Address:
2525 DEMERS AVE
Provider Second Line Business Practice Location Address:
SUITE B
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-746-5977
Provider Business Practice Location Address Fax Number:
701-746-5976
Provider Enumeration Date:
11/03/2006