Provider First Line Business Practice Location Address:
1407 24TH AVE S STE 204
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:
58201-6761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-213-0426
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2008