Provider First Line Business Practice Location Address:
1191 SOUTH COLUMBIA ROAD
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:
58201-4033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-335-9717
Provider Business Practice Location Address Fax Number:
701-746-1663
Provider Enumeration Date:
10/25/2012