Provider First Line Business Practice Location Address:
3001 11TH ST. SO.
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-356-0062
Provider Business Practice Location Address Fax Number:
701-356-5412
Provider Enumeration Date:
11/16/2006