Provider First Line Business Practice Location Address:
3001 B 32ND AVE S
Provider Second Line Business Practice Location Address:
STE 1B
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:
701-256-3581
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2007