Provider First Line Business Practice Location Address:
2600 52ND AVE S STE 103
Provider Second Line Business Practice Location Address:
C/O URBAN EDGE
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58104-7173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-566-2708
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2013