Provider First Line Business Practice Location Address:
820 4TH STREET NORTH
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:
58122-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-234-2397
Provider Business Practice Location Address Fax Number:
701-234-3386
Provider Enumeration Date:
07/11/2006