Provider First Line Business Practice Location Address:
820 4TH ST N
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:
58102-4539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-234-6161
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2006