Provider First Line Business Practice Location Address:
2301 6TH 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:
58103-5303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-239-6827
Provider Business Practice Location Address Fax Number:
701-241-5775
Provider Enumeration Date:
04/25/2014