Provider First Line Business Practice Location Address:
360 DIVISION AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58201-4702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-757-4407
Provider Business Practice Location Address Fax Number:
701-757-4408
Provider Enumeration Date:
02/15/2016