Provider First Line Business Practice Location Address:
3534 UNIVERSITY DR S
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:
58104-6228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-271-1817
Provider Business Practice Location Address Fax Number:
701-271-1926
Provider Enumeration Date:
10/03/2012