Provider First Line Business Practice Location Address:
1729 SOUTH 16TH STREET
Provider Second Line Business Practice Location Address:
LEWIS AND CLARK ELEMENTARY
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-446-4835
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2008