Provider First Line Business Practice Location Address:
4350 S WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE #112
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58201-7184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-293-9829
Provider Business Practice Location Address Fax Number:
701-293-0111
Provider Enumeration Date:
08/10/2007