Provider First Line Business Practice Location Address:
2401 S WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58201-6747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-610-3673
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2013