Provider First Line Business Practice Location Address:
1165 S COLUMBIA RD STE C
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:
58201-4007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-772-7379
Provider Business Practice Location Address Fax Number:
701-772-9643
Provider Enumeration Date:
04/01/2014