Provider First Line Business Practice Location Address:
101 10TH ST N
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58102-4600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-239-9771
Provider Business Practice Location Address Fax Number:
701-293-0944
Provider Enumeration Date:
09/08/2009