Provider First Line Business Practice Location Address:
1515 N 5TH ST
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:
58203-1509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-268-0954
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2026