Provider First Line Business Practice Location Address:
1422 CENTRAL AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST GRAND FORKS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-773-6102
Provider Business Practice Location Address Fax Number:
218-955-7150
Provider Enumeration Date:
07/24/2023