Provider First Line Business Practice Location Address:
2800 S COLUMBIA RD
Provider Second Line Business Practice Location Address:
J.C. PENNEY OPTICAL-COLUMBIA MALL
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58201-6076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-746-4810
Provider Business Practice Location Address Fax Number:
701-746-9260
Provider Enumeration Date:
01/24/2006