Provider First Line Business Practice Location Address:
151 S. 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58206-5196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-787-8556
Provider Business Practice Location Address Fax Number:
701-787-8556
Provider Enumeration Date:
10/04/2011