Provider First Line Business Practice Location Address:
1000 S COLUMBIA RD
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:
58201-4032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-772-4875
Provider Business Practice Location Address Fax Number:
701-780-6577
Provider Enumeration Date:
07/05/2006