Provider First Line Business Practice Location Address:
2401 S WASHINGTON ST STE F
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:
58201-6747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-248-8216
Provider Business Practice Location Address Fax Number:
866-792-0267
Provider Enumeration Date:
11/20/2009