Provider First Line Business Practice Location Address:
2750 S 26TH ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58201-6432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-757-1999
Provider Business Practice Location Address Fax Number:
701-757-0898
Provider Enumeration Date:
09/17/2013