Provider First Line Business Practice Location Address:
100 4TH ST 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:
58103-1929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-234-4141
Provider Business Practice Location Address Fax Number:
701-234-4137
Provider Enumeration Date:
09/07/2006