Provider First Line Business Practice Location Address:
820 4 STREET NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
58122
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:
701-234-3861
Provider Enumeration Date:
02/08/2006