Provider First Line Business Practice Location Address:
1717 SOUTH UNIVERSITY DRIVE
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:
58122-0344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-280-4497
Provider Business Practice Location Address Fax Number:
701-280-4490
Provider Enumeration Date:
05/01/2007