Provider First Line Business Practice Location Address:
1200 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-780-5280
Provider Business Practice Location Address Fax Number:
701-780-1097
Provider Enumeration Date:
06/27/2015