Provider First Line Business Practice Location Address:
1324-23RD ST. S.
Provider Second Line Business Practice Location Address:
STE 1A
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58103-3702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-238-5616
Provider Business Practice Location Address Fax Number:
701-271-8813
Provider Enumeration Date:
01/27/2010