Provider First Line Business Practice Location Address:
3001 S COLUMBIA RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58201-6064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-795-8818
Provider Business Practice Location Address Fax Number:
701-795-4888
Provider Enumeration Date:
01/02/2014