Provider First Line Business Practice Location Address:
212 S 4TH ST STE 401
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:
58201-4776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-775-7725
Provider Business Practice Location Address Fax Number:
701-775-7880
Provider Enumeration Date:
08/23/2013