Provider First Line Business Practice Location Address:
2812 A 17TH AVE S
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-775-3101
Provider Business Practice Location Address Fax Number:
701-775-0017
Provider Enumeration Date:
08/21/2006