Provider First Line Business Practice Location Address:
1726 S WASHINGTON ST STE 33A
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:
58201-6395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-746-4584
Provider Business Practice Location Address Fax Number:
651-925-0057
Provider Enumeration Date:
01/16/2023