Provider First Line Business Practice Location Address:
3535 S 31ST ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58201-3591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-780-6821
Provider Business Practice Location Address Fax Number:
701-780-1973
Provider Enumeration Date:
10/08/2008