Provider First Line Business Practice Location Address:
2600 DEMERS AVE STE 110
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:
58201-4100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-773-2945
Provider Business Practice Location Address Fax Number:
218-773-3015
Provider Enumeration Date:
02/05/2014