Provider First Line Business Practice Location Address:
117 N 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:
58203-3450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-746-1481
Provider Business Practice Location Address Fax Number:
701-746-6201
Provider Enumeration Date:
03/15/2017