Provider First Line Business Practice Location Address:
112 UNIVERSITY DR N STE 385
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:
58102-4661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-235-5450
Provider Business Practice Location Address Fax Number:
701-325-2338
Provider Enumeration Date:
10/12/2026