Provider First Line Business Practice Location Address:
400 OXFORD ST, STOP 7135
Provider Second Line Business Practice Location Address:
NPCBR ROOM 220
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58202-7135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-777-2669
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2026