Provider First Line Business Practice Location Address:
301 NP AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58102-4835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-551-2448
Provider Business Practice Location Address Fax Number:
701-271-1480
Provider Enumeration Date:
07/16/2006