Provider First Line Business Practice Location Address:
1720 UNIVERSITY DR S RT 1707
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:
58103-6104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-234-1728
Provider Business Practice Location Address Fax Number:
701-234-1681
Provider Enumeration Date:
05/05/2006