Provider First Line Business Practice Location Address:
3535 S 31ST ST STE 201
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:
58201-3593
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-780-6821
Provider Business Practice Location Address Fax Number:
701-780-1973
Provider Enumeration Date:
04/26/2012