Provider First Line Business Practice Location Address:
2900 14TH 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:
58201-4042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-787-7900
Provider Business Practice Location Address Fax Number:
701-787-7901
Provider Enumeration Date:
12/01/2006