Provider First Line Business Practice Location Address:
1321 S WASHINGTON ST
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:
58201-5434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-757-2100
Provider Business Practice Location Address Fax Number:
701-772-8049
Provider Enumeration Date:
06/04/2013