Provider First Line Business Practice Location Address:
737 NORTH BROADWAY
Provider Second Line Business Practice Location Address:
SANFORD UROLOGY CLINIC
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-234-2301
Provider Business Practice Location Address Fax Number:
701-234-2130
Provider Enumeration Date:
06/27/2012