Provider First Line Business Practice Location Address:
N UNIVERSITY DR AT 17TH AVE N
Provider Second Line Business Practice Location Address:
BISON SPORTS ARENA
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-231-6492
Provider Business Practice Location Address Fax Number:
701-231-5189
Provider Enumeration Date:
03/19/2007