Provider First Line Business Practice Location Address:
1200 S COLUMBIA RD
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:
58201-4012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-780-2311
Provider Business Practice Location Address Fax Number:
701-780-2599
Provider Enumeration Date:
02/28/2018