Provider First Line Business Practice Location Address:
1501 17TH AVE. S.
Provider Second Line Business Practice Location Address:
FIRST BAPTIST CHURCH
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-235-6361
Provider Business Practice Location Address Fax Number:
701-235-6361
Provider Enumeration Date:
02/14/2007