Provider First Line Business Practice Location Address:
824 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58203-3547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-230-1700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2006