Provider First Line Business Practice Location Address:
706 38TH ST NW
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58102-2953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-893-9217
Provider Business Practice Location Address Fax Number:
701-893-9223
Provider Enumeration Date:
10/12/2006