Provider First Line Business Practice Location Address:
1521B 24TH AVE S STE 203
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:
58201-6775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-885-7920
Provider Business Practice Location Address Fax Number:
701-757-0859
Provider Enumeration Date:
03/20/2015