Provider First Line Business Practice Location Address:
1604 S WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58201-6334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-739-5131
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2015