Provider First Line Business Practice Location Address:
2400 32ND AVE S
Provider Second Line Business Practice Location Address:
ALLERGY/ASTHMA CLINIC SOUTHPOINTE
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:
701-234-2660
Provider Business Practice Location Address Fax Number:
701-234-8796
Provider Enumeration Date:
08/15/2007