Provider First Line Business Practice Location Address:
3001B 32ND AVE S STE 2B
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:
58201-6068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-747-0770
Provider Business Practice Location Address Fax Number:
701-425-0524
Provider Enumeration Date:
10/02/2007