Provider First Line Business Practice Location Address:
2401 SOUTH WASHINGTON ST
Provider Second Line Business Practice Location Address:
STE A
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-772-3487
Provider Business Practice Location Address Fax Number:
701-772-4917
Provider Enumeration Date:
08/05/2006