Provider First Line Business Practice Location Address:
2501 32ND AVE S STE B
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:
58201-6573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-795-1441
Provider Business Practice Location Address Fax Number:
701-335-2443
Provider Enumeration Date:
10/03/2006