Provider First Line Business Practice Location Address:
2600 DEMERS AVE STE 103
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:
58201-4100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-773-5840
Provider Business Practice Location Address Fax Number:
701-234-6859
Provider Enumeration Date:
12/06/2007