Provider First Line Business Practice Location Address:
3003 32ND AVE S
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58103-6163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-293-8101
Provider Business Practice Location Address Fax Number:
701-293-7998
Provider Enumeration Date:
07/29/2008