Provider First Line Business Practice Location Address:
2829 UNIVERSITY DR S
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58103-6050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-241-9300
Provider Business Practice Location Address Fax Number:
701-235-4525
Provider Enumeration Date:
07/17/2006