Provider First Line Business Practice Location Address:
1375 SOUTH COLUMBIA ROAD
Provider Second Line Business Practice Location Address:
SUITE A
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-780-2327
Provider Business Practice Location Address Fax Number:
701-780-2374
Provider Enumeration Date:
11/16/2018