Provider First Line Business Practice Location Address:
2860 10TH AVE N
Provider Second Line Business Practice Location Address:
STE 350
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58203-2262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-795-9355
Provider Business Practice Location Address Fax Number:
701-738-0055
Provider Enumeration Date:
07/10/2006