Provider First Line Business Practice Location Address:
1701 4TH AVE SOUTH
Provider Second Line Business Practice Location Address:
JEFFERSON ELEMENTARY
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58103-1562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-446-4700
Provider Business Practice Location Address Fax Number:
701-446-4799
Provider Enumeration Date:
03/10/2008