Provider First Line Business Practice Location Address:
1720 SOUTH UNIVERSITY DRIVE
Provider Second Line Business Practice Location Address:
SANFORD SOUTH UNIVERSITY
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:
701-234-2000
Provider Business Practice Location Address Fax Number:
605-622-2745
Provider Enumeration Date:
08/05/2011