Provider First Line Business Practice Location Address:
4440 S WASHINGTON ST
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:
58201-7245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-732-7700
Provider Business Practice Location Address Fax Number:
701-780-6088
Provider Enumeration Date:
02/19/2011