Provider First Line Business Practice Location Address:
261 GARFIELD AVE
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:
58201-7178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-232-8521
Provider Business Practice Location Address Fax Number:
361-232-8521
Provider Enumeration Date:
04/18/2026