Provider First Line Business Practice Location Address:
MCCANNELL HALL
Provider Second Line Business Practice Location Address:
ROOM 200
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58202-9042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-777-2127
Provider Business Practice Location Address Fax Number:
701-777-4189
Provider Enumeration Date:
08/26/2010