Provider First Line Business Practice Location Address:
3170 44TH ST. S.
Provider Second Line Business Practice Location Address:
SUITE 100
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:
701-235-2860
Provider Business Practice Location Address Fax Number:
701-235-4179
Provider Enumeration Date:
06/16/2006