Provider First Line Business Practice Location Address:
501 N COLUMBIA RD STOP 9037
Provider Second Line Business Practice Location Address:
DEPT OF SURGERY RM 5107,UNIVERSITY OF NORTH DAKOTA SMHS
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58202-9037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-777-3067
Provider Business Practice Location Address Fax Number:
701-777-2609
Provider Enumeration Date:
07/18/2012