Provider First Line Business Practice Location Address:
3301 30TH AVE S STE 101
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:
58201-6009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-780-9700
Provider Business Practice Location Address Fax Number:
701-780-9709
Provider Enumeration Date:
12/23/2022