Provider First Line Business Practice Location Address:
215 N 3RD STREET
Provider Second Line Business Practice Location Address:
SUITE 202A
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-772-7203
Provider Business Practice Location Address Fax Number:
701-772-7204
Provider Enumeration Date:
12/28/2006